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AI Claims Adjuster Assistant – Insurance Carrier Support

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Economical Basic AI Claims Adjuster Assistant Works Well

A basic AI claims adjuster assistant works well for insurance companies.  Think very basic.  If one looks at this article that I wrote many years ago on the workers comp claims adjuster job duties, a few of the tasks can be removed by a basic AI claims adjuster assistant where the benefit heavily outweighs the cost.

algorithms monty the robot pic
Wikimedia Commons – Jeff Keyzer

Phone Call and Email AI Assistant

No, it is not having an AI assistant that answers and directs phone calls.  Partially removing phone calls from the adjusters’ workloads will help the injured workers, employers, and the workers comp claims adjuster.

An insurance carrier or Third Party Administrator (TPA) can accomplish this by allowing online claims access by employers and injured workers.  Yes, I know that some TPAs and insurance carriers do this now – but not a large proportion.

I have recommended allowing employers full claims access for 20+ years. This access cuts down on status, reserve, etc. emails, and phone calls from employers. Kudos to those companies that have allowed employer and agent access.  This cuts down the workload a little.

I have always advised our employer, medical provider, and agent clients to email the claims adjuster.  The adjuster can review whatever is requested and then email a response and each party has documentation of the email – highly recommended at all times.

Injured Worker Access

The basic AI claims adjuster assistant which allows the injured workers partial access to their online file will remove some of the workload for the adjusters.   A carrier or TPA does not have to allow access to the whole file such as claim notes and reserving notes will remove the “we are afraid of getting sued” concern.

Partial online access that includes bill payments, indemnity payments, medical provider authorizations, and more evolves into a claims adjuster AI assistant.  Some insurance carriers and TPAs even have phone apps for this purpose.

Most of the phone apps seemed lacking when I tried them.  The apps may have been updated as my attempts to try them were pre-pandemic.

File access by all parties involved in a claim will turn out to be a great claims adjuster assistant – an easy fix.

 

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2 Responses

  1. I agree that access can cut down on time the adjuster is not involved in answering some of the more mundane questions like when will my next check be mailed, or when is the next medical appointment or scheduled diagnostic test and where. A virtual assistant Chat Box or Texting service can also be very useful to all parties. Having a written email record has become commonplace as an ask from an insured or agent.
    File note access is still not a recommended tool. Too many landmines that could lead to litigation and often Adjusters speak in WC shorthand that requires a word key and leads to more questions.
    We as an industry should continue to seek an understanding from all parties to the claim. We have to be inclusive to meet the needs of all non-English speaking parties as well. We need to continuously ask all parties what they need and or what would be helpful so that we can utilize tools such as AI to provide the answers on this speedway of data exchange that has to be ever evolving to meet the demands.

  2. Diana, thanks for your comment. Many of the carrier and TPA systems allow for limited access. I have heard those concerns in the past. Claim note access has always been a hot button. Should insured employers have access to the notes? I meant to convey that injured employees should only have limited claims access with the insured employer having a little more access.

    Once again, thanks for the reading the newsletter and articles. Feel free to contact me any time. [email protected]

Related...

James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications

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