How to Leverage AI for Insurance Claims Automation and Processing

Claims processing is one of the most critical aspects of customer experience in the insurance industry. According to a report by EY, 87% of surveyed policyholders¹ believe that these interactions impact their decision to remain with the same provider. For them, transparency and the speed of settlement are the most critical factors.

Customers always look for fast claim resolution and clear, timely updates, while insurers want to be accurate and efficient to avoid any risk of fraud and legal issues. Claims processing is an insurance provider’s most critical interaction with clients, as botched claims negatively impact customer satisfaction (CSAT) and operational expenses.

Primary reasons behind poor claims handling are outdated online platforms and slow, error-prone, and time-consuming manual processing. The lack of insurance claims automation means higher labor and operational costs, and limited scalability. The lack of traceability reduces transparency for both insurers and customers, leading to diminished trust and higher customer frustration.

Improving customer satisfaction with insurance claims automation

Insurance claims automation and processing with artificial intelligence (AI) can positively impact CSAT. AI platforms are capable of swiftly collecting and analyzing claim data to reduce time to settlements while increasing accuracy for greater compliance. Better, faster outcomes increase policyholder satisfaction and pave the way for cross-selling and upselling opportunities.

Using customer service AI, insurers enable seamless omnichannel customer interactions that allow policyholders to issue claims and receive personalized updates through their preferred channel —SMS, AI agents, social media, and more. Thanks to this integrated customer experience, policyholders enjoy consistent service through the submission and resolution workflow, significantly reducing reprocessing issues, minimizing human errors, and decreasing data discrepancies.

With Generative AI (GenAI) and Natural Language Processing (NLP), claimants feel like they are interacting with a human agent, which is also accessible 24/7/365 and capable of retrieving and processing information quickly and accurately. GenAI-powered channels like IVR and AI agents can identify customer intent, sense the sentiment of communication, and adapt their responses for a tailored, sympathetic interaction that increases their satisfaction and decreases call resolution time.

Reduced operational costs and insurance claims processing efficiency

Deploying contact center automation to improve insurance customer experience (CX) also has a significant impact on operational costs, from initial claim submission through document collection, assessment, and payment. By automating up to 90% of interactions, insurers can decrease their labor costs including training, recruitment, and turnover.

Via AI-powered claims automation systems, incoming customers can resolve claims issues and receive payments via self-service options. If a human agent is necessary, the customer is efficiently routed to the appropriate department based on predefined factors such as claim type, complexity, and urgency. This ensures that interaction is handled by the right expert, optimizing the use of available resources, and reducing processing times.

AI can deliver personalized recommendations and insights by analyzing client data and interactions. This allows insurers to provide customized services, anticipate client demands, and enhance insurance customer experience, which can result in increased retention rates and reduced costs associated with customer churn.

With insurance claims automation, insurers can also reduce costly mistakes that are all too typical when using manual data entry techniques. Errors in data interpretation can cause delays in claim processing, and misfiling documents or misinterpreting policy information can result in erroneous claims decisions and costly lawsuits.

AI-powered communications automation empowers insurance companies to streamline claims processing, reduce operational costs, improve efficiency, and deliver better customer service. By leveraging AI capabilities, insurers can achieve significant savings while enhancing the quality of their claims handling processes and improving customer satisfaction.

1. report by EY ↩︎