Is Removing Humans from the Claims Process a Good Idea?


Before we even get started, I know what you’re thinking; another artificial intelligence article projecting the future of AI in the insurance restoration industry. After all, it seems that the only thing people are talking about these days is how companies can leverage AI to help generate content, better educate staff, and improve client satisfaction. Rest assured, this is not one of those articles. 

To start this discussion, the reader should know that this industry harnesses vast amounts of both personal and property data. This information is layered on top of complex processes, procedures, regulations, and compliance requirements. In short, companies are struggling to keep up and organize the volume of information and documentation required to verify everything that has happened throughout the claim life cycle.

Can the Human Element be Replaced? 

I remember sitting in a general session at the Verisk Conference, listening to a keynote on the future of AI in the claims process. The presentation discussed the possibility of insurance agents being replaced with AI chatbots and how these bots would ultimately take over the settlement process of smaller claims. The demonstration showcased two speech bubbles: the AI agent and a policyholder who had recently experienced a loss. The agent could decipher damages using supporting images that the client had uploaded. It could also verify the authenticity of photos against potential fraudulent ones. The demonstration made it seem that the claim resolution process went seamlessly. No longer did the client have to wait on hold to talk to a live person, and they could get all their questions answered and the claim settled in a matter of minutes–amazing! 

You could hear the crowd murmuring, wondering whether this would be feasible in a real environment. Can you remove the human element altogether and still provide a great customer experience? Given how heavily this industry relies on communication, can this concept also be applied to the contractor side? All this is based on the premise that the data being captured and reviewed is relevant and accurate. It all seemed very hopeful, considering the complexities that can be encountered throughout the claims process. It has been stated in a previous AI article that one of the leading factors companies are pushing so hard for artificial intelligence is because of an industry-wide labor shortage. Perhaps the introduction of AI will become this industry’s saving grace, not only to help increase productivity but also to elevate customer satisfaction.   

On a side note, have you ever tried calling an airline to rebook your flight, only to find yourself yelling into the phone, “Operator!” while standing in the middle of a packed terminal? Believe me when I say it is as bad an experience as it sounds. The problem ultimately comes from feeling stuck in digital purgatory when you just want to speak to a real person and get your issues heard and resolved as fast as possible so you can move on with your life. I can only imagine the emotional capacity of a person whose entire personal property had been lost due to fire or flood and is contacting their insurance for immediate assistance. How will they feel when, instead, they are thrown into the clutches of an automated message or chatbot without empathy or concern for their well-being? 

Joining Forces: Seeking Collaboration Between AI and Humans  

I see a world in which AI can provide better client-centric tools that allow humans to work smarter and reduce client friction, optimizing every touch point during the claim life cycle. Having worked within software development for the past 14 years, we have spent a lot of time looking for ways to help contractors move away from paper-based processes, starting with educating them on the importance of data. Keep in mind that AI is based on models, and those models are only as good as the information they have access to. We are constantly looking for ways to change the contractor business culture from one that is reactive in nature to one that is much more proactive and leverages information to drive business decisions. What we have found being in this industry since 2002 is that only systems that are integrated into the insurance ecosystem are able to provide real-time and meaningful data back into the hands of the people doing the work.  

As an innovator in restoration, software has played an instrumental role in allowing contractors and carriers to share information throughout the claims process. In the past few years, we have seen this industry grow in leaps and bounds regarding the number of software tools that connect within the overall ecosystem. It has allowed systems like ours to eliminate duplication and streamline the claims documentation process, allowing companies similar to ours to utilize AI to create a frictionless experience for contractors and customers. 

For example, imagine a call comes into your office and is identified in the first ring as the data captured within the caller ID identifies if the person calling is a new or existing customer. The client is then relayed to a live agent, who is presented with all the details needed to create a job. The loss address matches the contractor’s service area, and on-call staff are identified and notified via SMS of the new loss. At the same time, the client receives an SMS link providing a customer portal with updates on drive time and details on the contractor business, along with the ability to share additional documentation and photos before the live agents ever hang up the phone.  

Rather than replacing the human element altogether, this vision of AI in restoration seeks to embrace collaboration between the two. By leveraging the power of information directly connected to the insurance ecosystem, contractors will be able to provide a frictionless customer experience that breaks down barriers of disconnected solutions and paper-based processes. This TikTok generation of customers has a different tolerance and patience than customers did even a few years ago. Industry leaders are looking for more ways to focus AI on customer-centric behaviors that can help forecast potential problems before the customer is even aware of them. 

Nobody knows what the future holds, but there is no going back to how things were before AI’s introduction. While artificial intelligence holds immense potential, in my mind, it is only part of the overall solution, especially in an industry that still values the human touch.  

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Ryan Pritchard

Ryan PritchardRyan Pritchard is the Sales Manager for Canam Systems developer of PSA. He has spent the last 15 years in Customer Service & Sales. Ryan joined the PSA team back in 2010 and has been working with Property Restoration Contractors for over 11 years.  He continues to provide strong company growth, promoting and selling Proven Software Applications as the leading ERP software for Property Restoration. Over the past 5 years, he has been involved in working with the PIRC to help standardize data within the Insurance Ecosystem.


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