Can We Improve the Traditional Claim Review?
Claim Review 101
Claim Reviews are an essential task in the world of P&C insurance. In a world of evolving risks and advancing technologies the Claim Review process has not evolved much over time. Most Claim Reviews completed in today look very much like Claims Reviews from the 1990’s or even the 1980’s.
Before a single review takes place, the claims professional has much to do including a line-by-line audit of each claim in the client’s caseload. This labor intense process creates capacity constraints on adjusters who already have an assigned caseload with claims to investigate, evaluate and resolve. The preparation for these Claim Reviews can take many hours and even days for the claims professional to complete. It is typical for an experienced adjuster to prepare for and attend multiple Claim Reviews each month. It is common for brokers, MGAs, policyholders, self-insureds and carriers to request monthly, quarterly, annual and even some ad hoc Claim Reviews.
The insurers want to stay informed on new claims, pending claims, re-opened claims, claim financials, emerging risks, litigation involvement, any other insights into their risks/book of business and obtain a deeper understanding about the cause of loss on the individual claims. Each claim is discussed in detail to assess if the claim is compensable, or if the insured has committed negligence, is there the potential for a nuclear verdict or is there is an affirmative defense in that venue. The alleged injuries/damages of the claims are reviewed along with the claim timeline to develop an agreed approach to resolve the claim in good faith. So, for many years the burden of preparing for the Claims Reviews has rested primarily with the claim professionals. Claim Reviews are and will remain part of the claims eco-system.
Is There a Better Way?
Yes,artificial intelligence can dramatically improve and speedup the process of Claim Review preparation. Claims organizations can reap the benefits of AI by choosing tools uniquely designed to remove friction and simplify processes.
While you may be familiar with tools like ChatGPT, Gemini, or even an earlier iteration of Siri. These generalist AI tools are great, but finding the right fit for your industry and profession is essential. Many of today’s more advanced AI tools are not trained on insurance claims data nor are designed to generate intelligence that would be helpful in a claim review.
Document intelligence For the Modern Claim Review
That is where CLARA’s Claims Document Intelligence Pro come in. Claims DocIntel Pro is a tool that augments Claims Review process by visually organizing and presenting claim summarizations, risk trends and insights, claim financials and treatment timelines with both the structured claims data and claims documents. CLARA’s unique approach to document intelligence is to offer a tool that trains relevant and abundant claims data which is then utilized to inform the claims professional and augment manual tasks like Claim Reviews.
Utilizing document intelligence to understand claims documents is helpful, but is it what you really need? You’ve struck gold when you find a tool trained in claims data that synthesizes the art (decision-making) and science (data) of what you do. That’s what we call augmented intelligence.
In a sea of AI options, choose the tool that boosts accuracy, efficiency, productivity and claim outcomes. CLARA’s Claims Document Intelligence Pro was trained on millions of closed claims, meaning you can trust that the outputs are designed to improve your adjuster’s productivity by removing friction and simplifying processes. CLARA doesn’t just offer document intelligence; it augments the adjuster’s job by eliminating manual processes saving your organization time and money. Claims DocIntel Pro will make your CFO and your claims team smile!
Schedule a demo today to see CLARA Fraud and the rest of CLARA’s AI solutions in action.
