Working in a claims department can be incredibly rewarding, especially when experts are empowered to focus on meaningful work. I say it can be because, even though I last worked in claims over 20 years ago, things haven’t changed much since then. Even as technology has evolved, the intensive manual effort required to organize data, review medical bills, and manage attorney communications remains a daily struggle.
The insurance industry is experiencing a talent shortage that’s expected to worsen over the next five years. So, what can we do now to make claims roles more appealing and fulfilling in the future
Introducing artificial intelligence (AI) is one way to help "re-claim" this critical role for human experts. We can recenter these positions to focus on the skills that matter most – data analysis, human judgment, empathy, and strategic decision-making, areas that add the most value to the customer experience. Let AI take on the repetitive tasks so claims professionals can do the work that’s more challenging, more impactful, and more satisfying.
Let’s take a closer look at a range of claims tasks to see how AI delivers support across the entire process – and more importantly, what that means for the claim's professional in terms of elevated responsibilities and more valuable and engaging work.
AI-Driven First Notice of Loss (FNOL) Process
AI can play a vital role in the initial stages of the claims process by handling first notice of loss (FNOL) intake using AI agents.
AI agents operate 24/7 and can collect essential claim details, verify policy information, search for relevant data, and prompt claimants to provide any missing documentation or answers needed to move the claim forward.
This information is seamlessly entered into the claims system, reducing manual effort and potential errors while enabling faster triage. With these tasks managed by AI, claims professionals can have meaningful interactions with agents and policyholders, using their expertise to offer empathy, navigate complex issues, and speed resolutions to support a smooth recovery process for the insured.
Automated Claims Triage and Assignment with AI
An AI agent can assess the severity, complexity, and risk associated with each claim and route it to the appropriate adjuster based on predefined rules and training. In some cases, AI can even fast-track straightforward claims for straight-through processing – up to 99% in some cases. This allows team members to dedicate more time to high-touch cases that demand negotiation, litigation oversight, or specialized handling.
By streamlining claim distribution, AI not only improves operational efficiency but also ensures your team is focused where their expertise delivers the greatest value.
Automated Claims Validation and Coverage Analysis with AI
As new claims are submitted, AI agents can automatically review policy limits, exclusions, endorsements, and claim history to minimize interpretation errors and ensure compliance. It can also generate clear summaries to further streamline the process.
Coverages and exceptions can be confusing or open to interpretation, which is where human expertise is essential. With this foundation in place, claims experts can focus on resolving complex or ambiguous cases and engaging with agents, customers, or legal teams to ensure fair and accurate outcomes.
This collaboration between AI and human judgment leads to faster decisions, reduced errors, and a more confident and informed claims experience.
Smarter Document Processing and AI-Driven Data Extraction
AI agents can take large volumes of bills, repair estimates, police reports and other correspondence, and extract the data and summarize it for the claims team member. This is yet another way AI speeds claim setup and reduces delays due to missing information. This empowers your claims professionals to analyze key facts instead of digging for information or manually entering data into your systems.
Optimizing Medical Bill Review with AI
An AI agent can automatically validate medical bill charges against fee schedules, medical necessity, and prior treatment patterns. Handling high document volumes and ensuring consistency in medical reviews while the claims professional investigates complex medical cases, identifies potential fraud and coordinates with medical experts.
Advanced AI Techniques for Fraud Detection
Adjusters overburdened with excessive manual tasks and high workloads are more prone to errors. Insurers can significantly reduce losses by leveraging AI to detect anomalies, recognize suspicious patterns, and flag potential fraud early in the process. This allows claims professionals to shift their focus to higher value work, such as digging deeper into complex cases and partnering with Special Investigations Units (SIU) to drive more effective fraud outcomes.
In short, AI acts as an intelligent first line of defense and empowers claims experts to operate with greater precision, insight, and impact.
Modernizing Communication Management with AI
We’re all flooded with an endless deluge of emails every day. AI agents ease this burden by summarizing threads, flagging what’s truly urgent, and responding to routine inquiries. Instead of spending their day digging through every message, your team can focus on meaningful conversations, manage exceptions, and keep claims progressing. It’s about giving them back their time so they can do the work only they can do.
In addition, AI can streamline outgoing claims communication by drafting messages such as acknowledgments, status updates, and settlement notices, all tailored to claim-specific details. An AI agent can adjust tone, attach necessary documents, ensure compliance, and deliver messages through the designated channels. By automating repetitive administrative tasks, AI enables claims teams to deliver responsive policyholder communications for thoughtful, personalized service.
AI-Backed Litigation Support and Subrogation Intelligence
AI can analyze claim files to uncover subrogation opportunities and generate litigation summaries, helping to reduce the chance of missed recoveries. This allows experts to concentrate on driving results, pursuing reimbursements, collaborating with legal counsel, and making informed, strategic decisions.
AI-Augmented Claims File Review Process
AI can assist with claim reviews by analyzing large volumes of data quickly and consistently, identifying patterns, flagging discrepancies, and comparing current claims against historical outcomes. It can extract key details from documents, highlight potential coverage issues, and recommend next steps based on similar past cases. Rather than replacing the claims professional, AI acts as a powerful support system that enhances accuracy, saves time, and enables them to bring greater insight and value to every claim they touch.
Accelerating Large Loss Report Preparation Using AI
AI transforms large loss report preparation from a time-consuming, manual task into a faster, more accurate, and collaborative process.
AI agents can gather and organize relevant claim data from internal systems, summarize lengthy documents such as adjuster notes and legal correspondence, and provide reserve recommendations based on analysis of similar historical claims. AI can also generate clear timelines, visualizations, and narrative drafts that outline the loss, actions taken, and next steps, giving claims professionals a strong starting point.
As new information comes in, the AI agent updates reports in real time, eliminating the need to manually rebuild. It also supports collaboration by tracking changes and managing version history, making it easier for teams to finalize reports efficiently, processing these complex documents up to 90% faster.
Next-Level Claims Analytics & Reporting Powered by AI
AI has been proven to significantly reduce the time claims professionals spend pulling reports by automatically generating KPIs, identifying loss trends, and recommending reserve amounts based on data-driven analysis. These AI-generated insights support better forecasting and financial accuracy while giving professionals the tools to make faster, more informed decisions. With AI handling the data-heavy tasks, claims experts can focus on refining processes and supporting leaders in evaluating team performance.
Ultimately, AI enhances both operational oversight and financial precision, opening team capacity for high-demand periods, and enabling your experts to act with greater confidence and strategic focus.
I’ve highlighted several use cases that show how AI can drive meaningful efficiencies within your claims department while transforming traditional roles into more engaging, skill-driven positions.
You don’t need to implement every use case to see results. What matters most is identifying the areas where AI can deliver the greatest impact for your organization. AI improves efficiency and team ROI by creating opportunities for claims professionals to evolve and expand their careers.
In a time when CAT losses and price pressure are placing greater demands on efficient claims management, future-forward claims teams have the opportunity to step up to improve every link in the insurance value chain. Now is the time to start shaping your AI strategy, to re-center your claims operations around efficiency and innovation. By committing to AI transformation now, you are creating a foundation to attract and inspire the next generation of insurance professionals to solve our industry’s greatest challenges.
The future of claims isn’t about doing more with less. It’s about doing better with purpose while serving your customers with speed, accuracy, and care. Embrace AI, empower your people, and reimagine what’s possible.
Curious how insurers are putting Roots to work? Check out our case studies to see insurance-specific AI in action.