SMA damage claims adjuster


Decades ago, a chorus began that predicted the death of the insurance agent. Internet was going to eliminate the intermediaries! Disintermediation would lead to the disappearance of the traditional insurance agent! But here we are – years later – and distribution intermediaries like agents, brokers, wholesalers and the like don’t just survive, they thrive. I believe adjusters and professionals in general are on a new and improved path.

The pandemic has served as a catalyst to accelerate the digital transformation of insurance, and claims are one of the preferred focus areas for the implementation of digital capabilities. As more claims information is captured and digitally managed, new opportunities to take advantage of AI technologies arise. This leads to a vision of full automation, high levels of straightforward processing, and (logically) a diminishing role for claims professionals. These themes are explored in a new SMA research report, “P&C claims in the post-pandemic era: emerge stronger, accelerate transformation. “There is tremendous momentum to leverage technology to automate and improve the claims process, but that doesn’t mean the role of the claims adjuster will become obsolete … and it’s reminiscent of the old Monty Python gag, where a old man is thrown onto a pile of bodies, only to announce that he is “not quite dead yet”.

This may be the case with the claims adjuster. In fact, the stage is set for the roles of complaints to be elevated as they focus on activities with high added value. And the phrase “not quite dead yet” doesn’t really do justice to the situation, for these roles because they are very much alive and evolving. The key lies in exploring the complexity of the disaster landscape.

There is no doubt that many simple complaints are best handled in an automated fashion, with digital workflows, connections to restoration partners, and AI-driven decisions. The ability to reduce cycle times and settle claims faster benefits everyone, especially the claimant.

But the reality is that there are many complex claims, especially those where serious injuries have occurred, where large commercial properties are affected, or where insured vehicles or property are linked to industries with unique risks. Add to that the vital areas of fraud detection and investigation, litigation, medical management and collections. And it is becoming clear that human expertise and experience will still have important roles to play. It is true that all of these areas will benefit from automation and adjusters will be helped by the capabilities of AI. However, the need for human-to-human connection, to empathize with claimants, and to exercise judgment in complex and multi-faceted situations will always be necessary and will remain the hallmark of good claims organizations.

For more information on the evolution of P&C claims, see our recent research report, “P&C claims in the post-pandemic era: emerge stronger, accelerate transformation. “This report identifies how insurers have responded throughout the pandemic and how claims technology plans have changed over the past 18 months. Digital transformation and AI technologies are also discussed, based on SMA surveys of P&C executives. Finally, a vision of the future of claims is presented, including the role of the claims professional. Far in the future, we still risk saying to ourselves: long live the claims adjuster !

This blog entry has been reposted with permission by SMA.


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