Three women with headsets working on computers.

The quality of claims management can make or break an insurer’s reputation. That’s because to most consumers, an insurer is only as good as its claims service. If insureds don’t get the support they need when they have a covered loss, they won’t hesitate to get their policy elsewhere for the promise of a better experience.

To meet consumer expectations, savvy insurers are investing in technology that can help streamline the claims process and ensure they and their broker partners provide an excellent customer experience. To accomplish this, they’re leaning into artificial intelligence, technology that helps businesses automate many mundane tasks so associates can focus their efforts where it counts most: on providing personalized support to help the insured become whole again—or get back to the job, in the case of workers’ compensation—as quickly as possible. 

“For us, AI is really about unlocking the potential for best-in-class claims activity,” says Jonathan Cook, vice president of product at Kinetic Insurance.

The challenges of traditional claims management

Anyone who’s submitted a workers’ compensation claim before knows that with it comes a lot of paperwork, digital or otherwise. This includes the claims submission, financial data, notes left by the adjustor, PDFs from doctors and more. It’s up to the claims team to make sense of the disparate information and ensure nothing slips through the cracks along the way.

“Claims always include a lot of very unstructured data,” notes Cook. “AI allows us to format this data in a way where we can identify the most important thing to do next. It helps us be proactive and take preventative measures to stay ahead of claims.”

For example, for a worker’s compensation claim, AI can quickly scan the unstructured data, including hand-written notes from doctors, and identify any work restrictions, such as no lifting more than 10 pounds. Then, taking it a step further, AI can scan jobs the policyholder has to find work that matches the restrictions. With the help of AI, the worker can get back to the job as soon and as safely as possible, which is a win for all parties.

“That would normally be a laborious process of having a human being go through all the documentation to find the key information, which is definitely a time-consuming and inefficient way to do it,” says Cook. “AI jump-starts the return-to-work process.”

How AI helps streamline claims processes

AI has become ubiquitous in recent years, and with good reason. It has seemingly unlimited potential to help humans optimize the way they work. But where to start? Cook likens AI to an eager intern who wants to do a good job but needs proper training to reach their full potential.

“There’s a training process for our AI models, too,” notes Cook. “Our job has been to figure out how to identify the opportunity of this new technology and apply it very quickly.”

He and his team of engineers rolled up their sleeves and got to work to see what AI could do to elevate and enhance the way they manage workers’ compensation claims.

“There have definitely been moments of surprise and delight at the level of responses and output we can get from loading in a bunch of claims and just asking questions,” Cook says. “AI was able to deliver results in minutes that would normally have taken hours. Surfacing information that may not have even been caught.”

Reaping the real-world AI benefits

At Kinetic Insurance, Cook and his team discovered ways to leverage AI to help with common workers’ compensation claims scenarios to help them provide even more exceptional service to insureds, including:

  • Keeping treatment plans on track
  • Accelerating return-to-work timelines
  • Preventing lost or overlooked data
  • Reducing idle claims

One way they’re using AI is to help keep treatment on track for workers with active claims. This involves using the technology to take a deep dive into the most important events in the lifecycle of a claim, such as critical doctors’ appointments when work restrictions are likely to change or a diagnosis might be adjusted.

“For example, a mild sprain may be revealed as a partial tear,” notes Cook.

When this happens, the claim becomes more complex, and AI can alert the claims team of this information so they can monitor related future milestones.

Using AI to keep tabs on dynamic data can also help expedite the return-to-work process. In the past, with data coming from various sources and in hard copy and digital forms, it was possible for an important update from the doctor to get lost in a file. The result was that sometimes insurers were paying claims for workers who could have safely returned to work much earlier.

“With AI, we’re able to sit down and very quickly give a customer a laundry list of light duty they can do that aligns with their work restrictions,” explains Cook. “So, if we know about it on Monday, we're going to get them into a light duty program on Tuesday.”

AI also helps insurers reduce the number of idle claims in the system.

“Sometimes claims get stuck,” says Cook. “They wind up in a holding pattern where the action plan is the same because there are no big changes and there’s no noticeable improvement for the injured worker.”

AI helps Cook and his team identify these claims so they can check in on them and make sure nothing has been missed and that the worker is getting the right treatment to get back on track with their health—and back to work.

On the horizon: The future of artificial intelligence

AI is already making a measurable impact on the quality of claims service Kinetic Insurance provides. Building on this early success, Cook and his team are looking for other ways AI can help them further optimize their processes to better serve insureds.

“What I get really excited about is the promise of a new emerging sub-category of AI known as Agentic AI,” he says.

Agentic AI has the ability to fully automate simple processes and complete the action. This enables the claims team to focus its resources on providing high-touch support for the most complex claims.

“AI is not going to deal with very complicated and nuanced things,” Cook says. “That’s where the humans come in and provide the best-in-class service our insureds—and their workers—deserve.”

Learn more

Kinetic Insurance is a Nationwide partner that helps brokers offer competitive workers’ comp with built-in safety tech. Learn more about Kinetic Insurance here.

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