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Moore: Basic AI Claims Adjuster Assistant Works Well

  • National

A basic artificial intelligence claims adjuster assistant works well for insurance companies. Think very basic.

James Moore

James Moore

If one looks at this article that I wrote many years ago on the workers' comp claims adjuster job duties, a few of the tasks can be removed by a basic AI claims adjuster assistant where the benefit heavily outweighs the cost.

Phone and email AI assistant

No, it is not having an AI assistant that answers and directs phone calls. Partially removing phone calls from the adjusters’ workloads will help the injured workers, employers and the workers' comp claims adjuster.

An insurance carrier or third party administrator can accomplish this by allowing online claims access by employers and injured workers. Yes, I know that some TPAs and insurance carriers do this now, but not a large proportion.

I have recommended allowing employers full claims access for 20 years. This access cuts down on status, reserve, emails and phone calls from employers. Kudos to those companies that have allowed employer and agent access. This cuts down the workload a little.

I have always advised our employer, medical provider and agent clients to email the claims adjuster. The adjuster can review whatever is requested and then send a response and each party has documentation of the email. Highly recommended at all times.

Injured worker access

The basic AI claims adjuster assistant that allows the injured workers partial access to their online files will remove some of the workload for the adjusters. A carrier or TPA does not have to allow access to the whole file such as claim and reserving notes, which will remove the “we are afraid of getting sued” concern.

Partial online access that includes bill payments, indemnity payments, medical provider authorizations and more evolves into a claims adjuster AI assistant. Some insurance carriers and TPAs even have phone apps for this purpose.

Most of the phone apps seemed lacking when I tried them. The apps may have been updated, as my attempts to try them were pre-pandemic.

File access by all parties involved in a claim will turn out to be a great claims adjuster assistant. An easy fix.

This blog post is provided by James Moore, AIC, MBA, ChFC, ARM, and is republished with permission from J&L Risk Management Consultants. Visit the full website at

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