Advancing Claims Processing: The Impact of Generative AI in Medical Summary Creation

By Connor Atchison, Founder & CEO, Wisedocs —

In what seemed like a matter of months across the end of 2022, talk of artificial intelligence (AI) flooded the globe. While AI has been around since the 1950s, the last part of 2022 brought more high-profile technologies to the fore, including generative AI “chatbots” such as ChatGPT. In general, the term ‘generative AI’ refers to the AI tools designed to create something new. Whether that ‘new’ is a digitally rendered painting of a rabbit or a summary of recent medical reports, generative AI uses its existing knowledge to create something that didn’t exist before.

What does this mean for the future of claims? When it comes to the claims process, AI in general is a welcome change. Artificial intelligence can be used to speed up the manual job of paperwork, without compromising the accuracy of the task. Through human in the loop processes, organizations can maintain human checkpoints for AI-automated work. This means more paperwork in less time.

AI helps with manual tasks like indexing documents or removing duplicates. AI tools can recognize written documents in a way traditional automation can’t, pulling out handwritten scribbles or an unstructured page. When used to prepare documents for workflows, AI makes it possible to deal with massive quantities of data – while a human worker ensures attention to detail. This means less time spent on paperwork, more files per day, faster processes, and more effective claims: for the industry, it benefits every level.

AI in the Insurance Industry

A recent study by Accenture suggests insurers use AI tools to handle underwriting tasks, generate medical insights, better engage with customers, and more. Generative AI tools can add another layer to the process. By creating summaries, reports, and other relevant insights AI frees up knowledge worker’s time, which means more meaningful work and a more efficient workflow.

All of this improves the organization’s bottom line. When it comes to AI in the insurance industry as a whole, AI helps mitigate the impact of economic slowdowns. Higher claims payouts and rising rates of underwriting loss push down profit margins at insurance companies, a burden that ultimately reaches the customer and the local agent. These underwriting losses are due to higher legal costs and more expensive payouts, in addition to macroeconomic factors that put pressure on operating costs.

Fortunately, research suggests technology is capable of turning profits around. In underwriting alone, insurers can see loss ratios improve 3 to 5 points, in addition to higher premiums and more customer retention, with AI. Digitization of manual processes, as well as more complex predictions and AI-based data models, can all offload significant costs.

Medical Summary Creation with Generative AI

Other areas of the business – like enlisting medical experts or processing a claim – are even more promising. Physicians spend up to 62% of their time per patient reviewing patient records. Medical record summaries, generated by AI, can significantly cut back this time. With AI generated summaries, physicians, underwriters, and third party medical examiners (among other parties) can extract medical information more quickly. This includes interactive medical timelines, templated summaries (which can integrate into a workflow), the ability to search and filter data by keyword, and annotation abilities.

Interactive medical summaries not only allow for lower costs for insurers (especially for those hiring third party medical evaluators or medical experts), it also means processing more files. Personal injury claims in the insurance industry take an average of 1.5 to 2 years to reach a final settlement or verdict. In cases like these, even a matter of days means providing a better experience for your claimant – or catching the details of a legal case in significantly less time.

Generative AI tools are a powerful way to create something new: and in the insurance industry, this ‘something new’ could change millions of lives. When AI tools are adapted to the needs of the claims industry, organizations can not only refine their workflows to improve customer, staff, and agent experiences, they save both money and time. All of this means ‘generating’ new things for the insurance industry – and creating a more positive space for the people involved.

About the Author

Connor Atchison is the Founder and CEO of Wisedocs, the smart way to review and summarize medical records. Connor is an experienced founder with a demonstrated history of working in health services, information technology, and management consulting. He aims to digitize a formerly manual industry through the adoption of artificial intelligence and machine learning to support tedious processes. As a former veteran with 12 years of military service under the Department of National Defence, he strives to change the process for filing health insurance and disability claims for insurance, legal, medical evaluators, and their claimants. Connect with Connor on LinkedIn or Twitter.

About Wisedocs

Wisedocs is the medical record review machine learning software platform for insurance carriers, healthcare providers, law firms, and TPAs to sort, review, and provide summaries and insights on medical records for the insurance industry. Wisedocs serves the auto, liability, disability, workers’ compensation, tort law, and similar markets. Wisedocs provides an easy-to-integrate solution for improved accuracy and speed to deliver improved outcomes in processing medical records. Wisedocs raised $4.1M USD in oversubscribed seed round in 2022. To learn more about Wisedocs and the smart way to review medical records, visit wisedocs.ai.

Source: Wisedocs