Will AI Make Claims Analysts Obsolete?

I recently hosted a webinar on the potential of GenAI in claims with industry experts Mike Fiato, Chief Claims Officer at Allstate, Brandy Patrick, President at Lexitas, and Amit Man, Co-Founder and CTO of DigitalOwl. One of the questions from our audience, hitting on a concern regarding AI's impact on staff, sparked a passionate discussion and brought out great insights from our panel.

"As I sit here reviewing 1,000 pages of medical records, I can see the potential of technology in this field. However, at what point does AI make human reviewers obsolete?"

To summarize a particularly insightful question that was raised: "As I sit here reviewing 1,000 pages of medical records, I can see the potential of technology in this field. However, at what point does AI make human reviewers obsolete?"

This is a great question and one that I frequently encounter in the field of Claims. There is a common concern that the use of AI for medical record reviews—which currently occupies a significant amount of time for claims adjusters and examiners—will eventually lead to humans being removed from the process entirely.

However, for claims analysts and examiners this concern is less critical than it often first appears. AI that’s been designed for medical records, like DigitalOwl’s, aims to  alleviate the burden of excessive administrative tasks, allowing claims professionals to shift their focus to areas where their expertise and human judgment are essential. This approach enables them to concentrate on high-value tasks that only a human can perform, rather than being consumed by routine paperwork.

For Brandy Patrick, it’s a question of what’s the “highest and best use” of a reviewers’ time? "When I think about how much time it takes to read a medical record, it’s about 5 minutes per page on average. That’s not the best use of my time—or a lawyer’s time, or a claim adjuster’s time—especially if there’s nothing relevant on that page. That’s why we’re using AI as much as we possibly can, in the safest possible ways we can," said Patrick.

"When I think about how much time it takes to read a medical record, it’s about 5 minutes per page on average. That’s not the best use of my time—or a lawyer’s time, or a claim adjuster’s time—especially if there’s nothing relevant on that page. That’s why we’re using AI as much as we possibly can, in the safest possible ways we can," said Patrick.

While AI designed for medical records is excellent at extracting specific information from thousands of pages of medical records, it can't explain the significance of what it's finding. That's where human expertise comes in—interpreting the data, understanding the context, and making informed decisions based on all the circumstances. AI lacks the ability to provide comprehensive analyses that consider the nuances and complexities necessary to truly change outcomes, which will prevent it from replacing human reviewers.

"AI will not make claims professionals obsolete. Instead, it will significantly enhance their value by enabling them to concentrate on making important decisions rather than spending enormous amounts of time searching for information,” said Fiato.

For Mike Fiato, the real power of AI isn't in replacing professionals—it’s in amplifying their capabilities. "AI will not make claims professionals obsolete. Instead, it will significantly enhance their value by enabling them to concentrate on making important decisions rather than spending enormous amounts of time searching for information,” said Fiato.

Additionally, Amit Man shared that the insurance industry is more protected from AI-related layoffs than many other sectors, largely because of its heavy regulation and strict requirements for fairness and accountability. These regulations demand human oversight and judgment to ensure compliance and uphold ethical standards, making it less likely for AI to replace human roles.

There is also the potential that using AI for medical record reviews will greatly enhance the experience of claims professionals by freeing them up to focus on their critical thinking and problem-solving skills. This shift allows them to engage more deeply in meaningful, high-value tasks. “When we’re able to amp up human empathy and reduce busy work with AI, we create a powerful work-life harmony. We’re actually engaging a broader spectrum of the human experience because the ability and freedom to create is suddenly unleashed because we no longer have the noise of those admin tasks,” said Patrick.

“When we’re able to amp up human empathy and reduce busy work with AI, we create a powerful work-life harmony. We’re actually engaging a broader spectrum of the human experience because the ability and freedom to create is suddenly unleashed because we no longer have the noise of those admin tasks,” said Patrick.

Rather than replacing the roles of claims adjusters and evaluators, the panelists discussed the greater likelihood that the ability to use AI during medical reviews would reshape the skill set employers seek when hiring for claims positions. Companies may increasingly look for professionals who can effectively collaborate with AI technologies to achieve better outcomes, emphasizing skills like critical thinking, problem-solving, and adaptability to new tools and systems.

I want to give a big thank you to Mike Fiato and Brandy Patrick for joining this webinar and sharing their valuable insights. It was a pleasure to collaborate with them and explore these evolving opportunities within the claims industry. 

If you missed it, you can watch the recording here.

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