This article was written with the assistance of AI and edited by Angela Sabarese.
In a recent CLM Tech Talk, Kate Riordan, director of Medicare Secondary Payer Initiatives for Casualty Solutions at Verisk, discussed how artificial intelligence (AI) is revolutionizing medical record review in bodily injury claims.
Challenges
Riordan highlighted several challenges facing the insurance industry, including increasing claim volumes, rising settlement costs, and a significant talent shortage. "Roughly 400,000 insurance professionals are expected to retire by the end of next year," Riordan noted, underscoring the urgency for technological solutions in an industry struggling with workforce gaps.
Riordan focused on how medical record review has become increasingly complex, with adjusters often facing "document dumps" containing thousands of unorganized pages filled with clinical terminology. She explained how Verisk's AI-powered technology can address these challenges by organizing documents, identifying duplicates, removing irrelevant pages, and extracting critical medical data points.
The AI Revolution
Riordan described the evolution of AI implementation in insurance, characterizing 2023 as "the year of experimentation," 2024 as focused on education, and predicting 2025 will be "the year of adoption and implementation" as the industry moves from understanding AI's capabilities to practical applications.
The benefits of AI implementation are substantial, according to Riordan. "The Boston Consulting Group had written up a report that they were seeing cost reductions of up to 20%, and increases in claims processing speed as much as 50% utilizing AI," Riordan shared, illustrating the technology's transformative potential.
However, Riordan emphasized that AI's purpose is to enhance rather than replace human expertise: "AI is not replacing your staff. It's really there to augment your team, automate that redundant administrative work, and enable your staff to use their expertise to focus on higher and more rewarding tasks."
The Tech Talk concluded with Riordan suggesting that medical record review represents an ideal starting point for insurers looking to implement AI solutions in their operations.