Claims Processing Automation: What Really Matters for IT Decision-Makers

As the insurance industry leads AI adoption today, there is no shortage of enthusiasm for bringing AI to claims. As insurers race to claims processing automation, IT leaders are the ones tasked with choosing a platform. But unlike the technology of previous generations, choosing an AI platform goes beyond just features and price. 

AI is a Unique Technology with Unique Specifications

AI as a technology is fairly novel. Generative AI can learn, reason, and think – which can come with its own challenges, strategies, and mindset. The differences in handling AI technology are most apparent when it comes to size: building your own AI model requires more development, training, and resources than other software options. Not only will your organization need to develop and debug these tools across thousands of data points, but you will also need an incredible amount of data to train it on. 

Even if you purchase an out of the box solution, choosing a claims documentation platform it’s no longer a simple discussion of ‘features versus price’. With security risks, compliance challenges, and new regulation on the horizon, IT leaders now need to look at whether their AI solutions are built ethically, trained appropriately, and supervised by humans. 

Choosing the Right Tool for Claims Processing Automation

What is the right claims documentation platform (CDP) for your enterprise? Well, that depends what you’re using it for. Insurance, claims, or legal professionals will have specific reports, forms, and documents that make up the bulk of their claims document processing needs. Despite operating in similar industries, these documents will not always be the same. 

For example, a claims team might use medical records to establish what caused the medical event, set a recovery timeline, or validate severity. For them, it’s often helpful to have an AI medical chronology. For a lawyer, those same medical records can be used to support liability and find gaps or delays in treatment. Legal teams might like a tool that flags inconsistencies. Both parties are using the same medical paperwork – but their utility to each user, via a CDP, will not be exactly the same. 

Configurable claims processing automation systems like Wisedocs can help users create the reports, AI medical chronology and AI medical summaries they need, using industry specific data tailored to the company’s use case. This gives the customer outsized flexibility over their solution, without the enormous data requirements and development costs of building their own AI driven CDP.   

Enterprise-Grade Security & Compliance in Claims Processing Automation

Organizations in claims processing automation are responsible for handling some of the industry’s most sensitive data. Claims industry experts must comply with compliance regulations, safely handle PHI, and scale their operations without introducing new risk – or they could seriously harm the organization’s reputation and customer trust. While some vendors claim to be SOC 2 ready, that is not enough for many organizations in claims.

IT leaders in insurance should ensure that the vendor has completed a SOC 2 Type II audit, including security, availability, processing integrity, confidentiality, and privacy. SOC 2 is designed to help companies prove they can handle customer data responsibly. Additionally, IT leaders should ensure that AI driven claims processing automation platforms include human oversight into the process (to preserve data accuracy and prevent hallucinations) and enterprise-grade security. 

Faced with new options for claims processing automation, IT leaders are now tasked with exploring the how and why of their claims documentation tools. Beyond just features and price, IT leaders should take into consideration the many compliance, security, and quality features that differentiate today’s CDP tools. To learn more about what factors to consider when choosing a CDP, download Wisedocs’ Buyer’s Guide today for a practical guide to benchmark solutions, avoid common pitfalls, and choose a Claims Documentation Platform that fits your team—today and tomorrow.