Please ensure Javascript is enabled for purposes of website accessibility How AI and humans can partner for the future of claims management - Brown & Brown Absence Services Group

The war on talent is a well-documented challenge for the insurance industry. The number of employees aging out of jobs now and expected to do so through the next few years is significant. The insurance industry is unique in that its workforce tends to trend older, with those aged 55 or older now comprising about a quarter of the workforce. Unfortunately, the recent pandemic only increased the retirement rate for older workers, leaving gaps that may not have been planned for or filled.

Given the struggle to recruit and retain workers, carriers may lack consistency in the expertise they once had, especially in areas such as claims management. To keep pace with filling more senior roles that require specialized skills and knowledge means prioritizing the upskilling of current employees or finding resources outside their organization.

More complicating factors for claim management
The gap in claims expertise can uniquely affect the handling of complex claims. While complex claims are a small piece of a typical disability claim block, their complexity has increased due to both a rise in comorbidities and evolving work models requiring more from claims adjudicators. 

For example, the number of Americans living with at least one comorbidity is much more common. According to the latest CDC data, 1 in 3 adults live with high blood pressure, while the number of people living with diabetes is now at just over 11%. Growing comorbidities increase the complexity of a claim, thereby increasing the time to manage those claims along with the resources needed to provide claim direction.

In addition to growing health complications, return-to-work guidelines have posed challenges as well. The evolution of hybrid work models and the expansion of fully remote policies to attract and retain workers has added another layer to processing complex claims. 

Analytics – The future of claims management 
Despite present challenges, there are also more opportunities than ever to relieve some of the pressure on claims management. With advances in AI and automation, insurers are now looking to incorporate new technology into the claim process that can free up resources for more complicated claim work. 

Several products in the market today can analyze and automate aspects of the claims process. For example, bots are available to help auto-triage at-risk claims. Other tools can create a scoring methodology or automated claim trigger process by pulling claim information such as demographics and historical claim activity from a book of business. This presents the opportunity to develop specific triggers for claim follow-ups on files at critical intervals.

In addition to improving processing, some products can also optimize evidence-gathering. There is technology available that uses real-time structured data and claimant information to ask probing questions and extract relevant data from medical records. 

Finally, interactive applications are also available to help claimants provide real-time information about their conditions. This can be particularly impactful for behavioral health claims, providing further insight into a claimant’s return-to-work motivation and bringing out factors that could hinder or de-motivate claimants in such efforts (e.g., caring for a sick relative, money problems, marital problems, and work-related struggles before their claim began). 

For carriers looking to advance their claims management in addition to solving current resource challenges, layering real-time claim information over analytics and automation offers the ideal edge. Identifying current actions and behaviors of claimants, along with real-time mining of claimant information, both speech and text, combined with historical scoring, are the trifecta for managing claims for a forward-thinking operation.

The partnership approach for more efficient claims management
Brown & Brown Absence Services Group recently partnered with EXL, a leading data analytics and digital operations and solutions company. EXL has developed two industry-leading AI tools that can be used during claim intake and processing to provide a more comprehensive view of the claim and identify what could inhibit the individual from returning to work. 

    • Exelia: Exelia is a leading-edge intake engine that uses conversational AI to gather claim information by asking intelligent questions based on the responses received from the claimant/caller.
    • Extracto: Extracto is a tool that pulls unstructured data from medical records, lab reports, and other relevant medical documents for a particular claim and provides the reviewer with a detailed synopsis of the medical and claim information.

Combining available tools with data aggregated over the course of 10+ years through direct claim work, and automated decision-making on the easiest of claims, EXL has developed a cutting-edge, end-to-end claim experience.  But, for claims too complex for these AI and automation tools, Brown & Brown Absence provides the critical link. 

Consider the 80/20 rule – 80% of claims review tasks are routine and follow a pattern that generally is easier to manage. These are the tasks that EXL’s tools can best handle, while the remaining 20% of claims require a nuanced approach. These complex cases can be sent to Brown & Brown Absence to be managed by experienced claims staff. 

With a highly experienced staff, the team at Brown & Brown Absence Services Group is well-positioned to work with carriers seeking to employ advanced analytics and tools such as those offered by EXL. By working together, AI and human partnership are the future of claims management.