Spotlight on Claims Automation: Observations from the 2018 Eastern Claims Conference

At the 2018 Eastern Claims Conference in Boston, Massachusetts, the hot topic was  “Automation.”  From the keynote speaker addressing artificial intelligence (AI) to sessions on robotics, the need to modernize a claim organization by empowering, not replacing, the worker was the major theme.

Having spent the majority of the last 20 years helping companies with their business systems transformation, I’ve seen automation help claims organizations reach a higher level of efficiency and effectiveness.

If a claims organization truly wants to transform using tools, such as robotics and AI, it should think about how it helps the user.  The keynote speaker, John Standish of Infinilytics, said that currently 70% of a claim examiner’s time is spent gathering data/information and only 30% on actual decision making.  Automation can help with cutting down on mundane and inefficient items such as duplicate data entry,  manual calculations, unneeded or outdated tasks, processes, reports, etc.

However, automation should be planned wisely.  During the session on AI and Robotics presented by Howard Ehrlich and Barbara Grassie of Capgemini, they made many important key points:

  • If you cannot explain why something should be kept, such as a task or process, then consider it for elimination.
  • Up front, standardize using industry leading technology.
  • Optimize processes by removing steps that are “just because” and don’t make sense anymore.
  • Don’t automate just to automate and don’t automate in a vacuum. Automation should be business/ops driven, so bring in business people and users who know the pain points and can lend their expertise.
  • Use the 80/20 rule when figuring out what to automate and don’t automate the exceptions.
  • If there are documents, post-it notes, etc. hanging on cubicles or procedure manuals, that is the claim organization’s rules engine.
  • Robotics can help with data aggregation and information gathering.
  • Get more structured data up front (e.g., intake) in order to automate decisions, such as in the case of express processing of STD pregnancy claims or “simple” individual life/death claims.

John Standish made the statement that “machines are dumb” and I wholeheartedly agree.  It is up to the humans to teach the “machines.”  Working with FINEOS for the last 13 years, I have spoken to many companies about using our technology to automate decisions, correspondence, calculations, gather structured, data, etc.  With the addition of third party AI and robotics, FINEOS is primed to help claims organizations truly transform for the modern era. If you’d like to discuss this further, please contact me at

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