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Depending on the complexity of the claim, there are plenty
of instances where a "no touch" approach is essential.
Simple, common tasks such as state regulatory
compliance activities and form submissions can be totally
automated. But there are also process automated
scenarios where human intervention should be
anticipated and/or built into the system as an
enhancement. Initiatives such as "return to work" and
certain claims settlements -- especially those involving
bodily injury -- should be complemented with human
interaction to optimize the customer experience.
Analytics is being increasing used throughout the claims
process to help "guide" the claim to the appropriate
resource - human or technology. For instance, if a medical
claim exceeds a certain financial threshold, the system
can alert the risk manager to review the claim and
determine if it can continue through the automated
workflow or if it requires unique handling by a person.
These "triggers" help to optimize the human/technology
balance.
Threaded throughout our research is the consumer desire for an
intermixing of virtual and self-service with human adjuster interaction — a
hybrid claims processing model… Consumers appreciate the convenience
of online, self-service virtual processes, but when they want to talk to a
human nothing else can substitute — not even the most personable bot.
Having access to a representative dramatically increases consumer comfort
levels with automated claims processes across every group, and especially
for Baby Boomers. Comfort level increases even more substantially among
those who've recently submitted a claim.
- 2021 Future Of Claims Study, LexisNexis
McKinsey believes it's a combination of leveraging both resources.
"Leading claims organizations will evolve to combine and harness the best features of
artificial and human intelligence—and eliminate the blind spots in both. We expect humans to
continue to be essential to the claims process. And thanks to their use of digital enablers and
AI, they'll be able to work more productively and effectively."
