As a former claims examiner who spent years navigating the intricate dance of regulations, customer expectations, and the occasional policy anomaly, I’ve walked in the shoes of today’s claims professionals. Now, as Vice President of Product at a tech company focused on innovation in the insurance industry, I see a tremendous opportunity for technology—specifically agentic AI—to revolutionize the way death and living benefit claims are processed. But let’s face it: claims teams don’t adopt new tools just because they’re shiny and exciting.
The world of insurance claims is one where precision and caution rule. There’s no margin for error when grieving families or seriously ill policyholders depend on claims teams to get it right the first time. And therein lies the tension: while agentic AI offers incredible potential to enhance efficiency, accuracy, and customer satisfaction, the conservative nature of claims organizations may slow its adoption.
Let’s unpack why that is—and how agentic AI could still become the trusted partner claims professionals never knew they needed.
What Is Agentic AI, and Why Should Claims Teams Care?
First things first: agentic AI is not some runaway robot making decisions on its own. It’s a helper, a tool designed to assist claims professionals in doing their jobs better. Think of it as a colleague with an uncanny ability to sift through mountains of data, find patterns, and serve up actionable insights in record time.
For example, in death and living benefit claims, agentic AI can:
– Handle Paperwork Like a Pro: It can scan documents like death certificates and medical records, automatically extract the necessary details, and flag inconsistencies.
– Spot Potential Fraud Early: By analyzing patterns across data, it can identify red flags and bring them to a human’s attention before they become full-blown issues.
– Keep Teams in Compliance: With its ability to stay updated on regulatory requirements, agentic AI ensures claims are processed within the bounds of the law.
– Speed Things Up for Customers: No one wants to hear, “We’re waiting on another document.” Agentic AI can minimize back-and-forth delays, helping claims teams get answers to customers faster.
Sounds like a dream, right? But here’s the catch: claims teams don’t like to take chances.
Why Claims Teams Are Hesitant
I’ve been in the trenches, so I understand why claims teams are cautious. The stakes are high. If a claim is processed incorrectly, the fallout can include regulatory penalties, legal battles, and damage to a company’s reputation– not to mention the real-life impact on customers.
Claims professionals are meticulous for a reason, and introducing a new technology– even one as promising as agentic AI—can feel risky. Here are a few reasons why:
1. They Don’t Want to Lose Control: Claims examiners pride themselves on knowing their cases inside and out. Handing over even a fraction of that process to a machine can feel like relinquishing control.
2. It’s Hard to Trust What You Don’t Understand: Many claims professionals aren’t tech experts, and the idea of relying on AI can seem daunting or even intimidating.
3. Compliance Is King: The insurance industry is one of the most heavily regulated sectors out there. Before any new tool is adopted, it must be thoroughly vetted to ensure it meets every rule and standard.
4. Change Is Exhausting: Let’s be honest—claims teams are often stretched thin. The idea of learning a new system, no matter how beneficial it might be, can feel overwhelming.
So, Will Agentic AI Be Adopted?
I believe the answer is yes… but not without some hurdles. Adoption will require a careful, thoughtful approach that respects the unique challenges claims teams face.
Here’s what it will take:
– Education and Transparency: Claims teams need to understand exactly how agentic AI works and what it can (and can’t) do. Vendors and carriers must work together to show that AI isn’t replacing people; it’s empowering them.
– Proof It Works: Words are one thing; results are another. Pilot programs, case studies, and real-world examples of how agentic AI has improved efficiency and accuracy will be critical.
– Start Small: No one’s going to hand over their entire claims process to AI on day one. By starting with low-risk tasks like document review or fraud detection, claims teams can ease into using the technology.
My Perspective
As someone who’s spent years on the claims side, I know how exhausting and complicated the work can be. I also know how rewarding it is when you can help someone in a difficult moment by doing your job well.
Agentic AI isn’t here to replace that human connection—it’s here to enhance it. By taking on the tedious, time-consuming parts of the job, it gives claims professionals more time to focus on what really matters: helping people.
But I also understand the hesitation. The claims world is one where “better safe than sorry” is the rule, not the exception. And while I believe agentic AI is the future, it’s going to take time, trust, and a lot of collaboration to get there.
So, to my friends in claims: Don’t fear the tech. Test it, question it, and make it work for you. After all, you’ve spent your career being the experts people rely on—and agentic AI might just be the next great tool in your toolkit.
Krista Eger
Vice President of Product
