Automated Claim Assignments

Insurance companies and TPAs are increasingly using artificial intelligence (AI) to streamline and improve the process of assigning and handling claims.?

When I was a Team Lead, the state in which was noted in the first report of injury (it was not always right) was sent to a shared Outlook Inbox. Various Team Leads who managed claims in those states would go there, find their clients, and assign them to the adjusters on their teams.

Picking the correct adjuster took some thought. ?In my case, I handled over 60 accounts, so sometimes I wasn't even sure if they were my client. But then I'd have to read the first report of injury and triage it. ?For example, was it a repeat offender with lumbar radiculopathy or a pinky sprain? ??I'd have to enter a new assignment supervisor note and provide some direction and off it went.?

If I was out of the office, I'd ask a TL to cover for me, but it was always a big ask because it was a time-consuming process and generally performed first thing in the morning and right after lunch. ?

Towards the end of my era as a TL, we got really close to automating assignments with Excel spreadsheets. ?That was back in 2015.

Today, insurance companies and TPAs are using AI-powered algorithms which can automatically triage those first reports of injury. ?For example, the algorithms can quickly categorize and prioritize claims based on their complexity and potential severity by looking at certain fields. This can help ensure high-priority or complex claims are assigned to experienced adjusters, while straightforward claims can be handled by less experienced staff, reducing assignment and processing times.

This is pretty incredible and very much needed. ?Most of us understand there is a talent shortage in the industry. ?If we have less people to handle the same amount of claims, we need to find ways to be more efficient. ?This is a great example of how the insurance industry is using AI.?