The insurance industry is facing a pivotal moment, with third-party administrators (TPAs) and claims adjusters navigating increasingly complex case management demands. Between ballooning caseloads, high staff turnover, and a looming retirement wave, the pressure on insurance professionals has never been greater. Add to this a fragmented claims process, and it becomes clear: the system is strained. However, artificial intelligence (AI) is emerging as an innovative tool in alleviating these growing pains and reshaping the future of insurance operations.

Overwhelmed and understaffed: a growing crisis

Claims professionals are at the heart of case management, but they’re reaching a breaking point. A 2022 workers’ compensation benchmark study by Rising showed that:

• 32% of respondents managed 126+ claims, far beyond industry norms.
• 55% of claims organizations experienced over 10% turnover in that same year.

Since that benchmark, the situation has only worsened. This isn’t just about employee well-being; overburdened workers result in slower claims processing, diminished service quality, and increased error rates, directly impacting claimants and insurers alike.

The retirement wave is coming

An even greater workforce shift is on the horizon. According to the Insurance Institute of Canada, 22% of property and casualty (P&C) insurance professionals are expected to retire by 2026. This mass exodus threatens to create a severe talent vacuum. 

What does this mean for the industry?

• Fewer experienced adjusters to manage complex claims.
• Institutional knowledge loss, impacting training and efficiency.
• Increased caseloads for remaining staff, compounding burnout risks.

Insurers must urgently rethink their strategies to manage claims more efficiently with a shrinking talent pool.

A fragmented system with a domino effect

This talent shortfall intensifies existing case management challenges. Adjusters and TPAs are often bogged down by disconnected systems and documentation platforms, redundant administrative tasks, and inconsistent workflows between carriers, providers, and legal teams.

When professionals are overwhelmed and unsupported by streamlined tools, delays and inefficiencies ripple across the entire claims process, resulting in prolonged recovery timelines for injured parties and increased costs for insurers.

AI serves as a vital case management ally

Despite the challenges, there’s a silver lining. AI is becoming an essential part of modern claims handling, reducing manual workloads and enhancing accuracy. McKinsey reports that over half of claims activities are already automated, proving the industry’s recognition of AI’s transformative value. AI-powered solutions like Wisedocs are stepping in to bridge the efficiency gap by:

• Automatically organizing and summarizing medical documentation.
• Improving document review speed and consistency.
• Reducing time spent on administrative tasks, freeing up adjusters for high-value decisions.

This technology doesn’t just support claims professionals, it redefines what’s possible in a high-volume, low-resilience environment.

Looking ahead

With retirements looming, caseloads climbing, and staff burnout accelerating, insurance organizations must evolve. Embracing AI solutions is no longer optional, it’s a strategic necessity to sustain case management functions. Those who adapt will not just weather the current storm, but emerge stronger to deliver faster, more accurate claims outcomes in an increasingly demanding industry.

To see how Wisedocs can streamline your claims process and reduce caseload pressure, book a demo today.