Automated Claims, Smarter Outcomes

Authors

  • Vikram Boga Author

DOI:

https://doi.org/10.5281/zenodo.20537510

Keywords:

Artificial Intelligence In Insurance, Automated Claims Processing, Insurance Operations Optimization, Cost Reduction Strategies, Customer Experience Enhancement, Claims Settlement Acceleration, Ethical AI Governance, AI-Driven Decision Support, Small Claims Automation, Operational Efficiency Gains, Customer Satisfaction Management, Competitive Advantage In Insurance, Claims Accuracy And Consistency, Service Quality Improvement, Customer Retention And Loyalty, High-Value Client Management, Digital Insurance Transformation, AI Monitoring And Oversight, Intelligent Claims Workflows, Experience-Driven Insurance Services.

Abstract

Over the past decade, claims processing has emerged as a primary area of interest for insurers exploring how artificial intelligence (AI) can reduce costs or enhance service quality. Several factors motivate this focus. First, processing claims represents a major operational expense—one that, if reduced, is likely to translate into greater profitability. Second, claims processing often significantly influences the customer experience and may even determine clients’ future purchase decisions. Finally, AI technologies tailored for claims processing have demonstrated the ability to deliver faster settlement of smaller claims without sacrificing accuracy. Provided that AI is applied within a carefully monitored, ethically governed framework, its integration into claims processing represents a genuine win-win opportunity.

But increasing the efficiency of claims processing is only half the story. Unless these savings translate into improved customer experience and satisfaction, the long-term gains may be illusory. Customers today demand – and expect – faster claims settlements. Organisations that can consistently meet these expectations are likely to enjoy a competitive edge, gaining not only customer satisfaction but also long-term loyalty. Conversely, companies that fail to deliver speedy settlements will, over time, see an increased rate of customer attrition, particularly among their high-value clients. Insurers that can harness new AI capabilities to manage these twin objectives – faster settlement with greater consistency – stand to capture both the operating and customer experience benefits.

References

[1] Bittner, E. A. C., Leimeister, J. M., & Wagner, S. (2023). Designing human–AI collaboration in insurance claims management. Information Systems Journal, 33(2), 287–318.

[2] Scanlan, J., O’Neill, C., & Walsh, P. (2022). Artificial intelligence adoption in insurance operations: Implications for claims processing. Geneva Papers on Risk and Insurance, 47(4), 623–646.

[3] Eling, M., Nuessle, D., & Staubli, J. (2022). The impact of artificial intelligence on the insurance industry. Risk Management and Insurance Review, 25(1), 1–25.

[4] Kofler, M., & Schwendner, P. (2021). Machine learning in claims fraud detection. Journal of Risk and Insurance, 88(4), 877–907.

[5] Brock, J. K. U., & Von Wangenheim, F. (2019). Demystifying AI in service encounters. Journal of Service Research, 22(3), 265–277.

[6] Huang, M. H., & Rust, R. T. (2021). Artificial intelligence in service. Journal of Service Research, 24(1), 3–19.

[7] Dwivedi, Y. K., Hughes, L., Ismagilova, E., et al. (2021). Artificial intelligence research agenda. International Journal of Information Management, 57, 101994.

[8] van den Broek, T., Sergeeva, A., & Huysman, M. (2021). Hiring algorithms, fairness, and explainability. Management Information Systems Quarterly, 45(3), 1–28.

[9] Guidotti, R., Monreale, A., Ruggieri, S., Turini, F., Pedreschi, D., & Giannotti, F. (2019). A survey of explainable artificial intelligence. ACM Computing Surveys, 51(5), 1–42.

[10] Ribeiro, M. T., Singh, S., & Guestrin, C. (2016). Model-agnostic interpretability of machine learning. ACM SIGKDD Conference Proceedings, 1135–1144.

[11] Doshi-Velez, F., & Kim, B. (2017). Towards a rigorous science of interpretable machine learning. arXiv Preprint.

[12] Mittelstadt, B. D., Allo, P., Taddeo, M., Wachter, S., & Floridi, L. (2016). Ethics of algorithms. Big Data & Society, 3(2), 1–21.

[13] Floridi, L., Cowls, J., Beltrametti, M., et al. (2018). AI4People—Ethical framework. Minds and Machines, 28(4), 689–707.

[14] Shneiderman, B. (2020). Human-centered artificial intelligence. International Journal of Human–Computer Interaction, 36(6), 495–504.

[15] Larsson, S., & Heintz, F. (2020). Transparency in artificial intelligence. Internet Policy Review, 9(2), 1–16.

[16] Amershi, S., Begel, A., Bird, C., et al. (2019). Guidelines for human–AI interaction. Proceedings of the ACM CHI Conference, 1–13.

[17] Sendak, M. P., Gao, M., Nichols, M., & Balu, S. (2020). Machine learning in healthcare and insurance operations. NEJM Catalyst, 1(6), 1–12.

[18] van der Aalst, W. (2021). Process mining and operational excellence. Communications of the ACM, 64(8), 76–83.

[19] Jans, M., Alles, M., & Vasarhelyi, M. (2014). Process mining in auditing and insurance. Accounting Horizons, 28(4), 815–843.

[20] Poursabzi-Sangdeh, F., Goldstein, D. G., Hofman, J. M., Vaughan, J. W., & Wallach, H. (2021). Manipulating and measuring model interpretability. Proceedings of the ACM CHI Conference, 1–15.

[21] Kellogg, K. C., Valentine, M. A., & Christin, A. (2020). Algorithms at work. Academy of Management Annals, 14(1), 366–410.

[22] Jarrahi, M. H. (2018). Artificial intelligence and the future of work. Business Horizons, 61(4), 577–586.

[23] Raisch, S., & Krakowski, S. (2021). Artificial intelligence and management. Academy of Management Review, 46(1), 192–217.

[24] Mariani, M., & Borghi, M. (2021). Industry 4.0 and AI in services. Journal of Business Research, 123, 468–482.

[25] Holmström, J., Holweg, M., Lawson, B., Pil, F., & Wagner, S. (2019). Digital operations management. Journal of Operations Management, 65(8), 728–734.

[26] Benbasat, I., & Zmud, R. W. (2003). The identity crisis within IS research. MIS Quarterly, 27(2), 183–194.

[27] Parasuraman, A., Zeithaml, V. A., & Berry, L. L. (1988). SERVQUAL. Journal of Retailing, 64(1), 12–40.

[28] DeLone, W. H., & McLean, E. R. (2003). The DeLone and McLean IS success model. Journal of Management Information Systems, 19(4), 9–30.

[29] Lacity, M., & Willcocks, L. (2018). Robotic process automation. MIS Quarterly Executive, 17(1), 1–13.

[30] Davenport, T. H., & Ronanki, R. (2018). Artificial intelligence for the real world. Harvard Business Review, 96(1), 108–116.

[31] Wirtz, J., Patterson, P. G., Kunz, W. H., et al. (2018). Brave new world: Service robots. Journal of Service Management, 29(5), 907–931.

[32] Vial, G. (2019). Understanding digital transformation. MIS Quarterly, 43(1), 223–247.

[33] Henke, N., Bughin, J., Chui, M., et al. (2020). The state of AI in insurance. McKinsey Quarterly, 4, 1–12.

[34] European Insurance and Occupational Pensions Authority. (2021). Artificial intelligence governance principles in insurance. EIOPA Discussion Paper.

[35] World Economic Forum. (2022). Artificial intelligence in financial and insurance services. WEF Insight Report.

Additional Files

Published

2025-06-18

Data Availability Statement

None

How to Cite

Automated Claims, Smarter Outcomes. (2025). American Data Science Journal for Advanced Computations (ADSJAC), 3(02). https://doi.org/10.5281/zenodo.20537510