Skip to content


Claims handlers and adjusters have varying levels of experience and a range of specialties. To utilize these abilities most efficiently, insurers need to match claims to the adjusters best prepared to deal with them. Insurers can rely on claims decisioning solutions to direct cases appropriately – if the tool is up to the task.

Insurers should align claims, but there’s a catch
Handling claims correctly means assigning more complex or specialized claims to the adjusters who are best equipped for them. An example is an auto insurer receiving a PIP claim. If that claim is handed to the least-experienced adjuster – who has little experience with PIP – then the claim may take longer to resolve and the resolution may contain errors.

The catch is that senior claims staff can’t spend time mulling over assignments. In terms of customer experience, adjusters who are ranked as “top-performing” will respond to the policyholder in just three minutes after FNOL

Three minutes is a very short time to align claims with adjusters. There’s not just experience to consider – there’s also the adjusters’ overall workloads, plus the relative complexity and value of the claim. 

Lastly, the overall number of claims is increasing in certain areas. In the auto industry, any increase in car crashes will lead to an increase in claims. In the life insurance industry, the pandemic is pushing a similar increase. Meanwhile, extreme weather events can drive larger and more frequent P&C claims.

In short, administrators should align claims with adjusters – but they can no longer do it manually. This idea is no longer compatible with customer expectations for speed or with overall claims volumes. The solution needs to be digital.

Aligning claims with adjusters – why AI?
Digitization is fast becoming a necessary part of aligning claims. Adding digital processes to claims intake will help ensure fast and accurate handling throughout the rest of the processing. Research has shown that digitizing the claims process can reduce the overall time to resolution by an average of 5.5 days – a massive boost to customer experience.

So, how to digitize the alignment process? And why use AI?

Insurers could likely write business rules to approximate the responses of AI, but business rules lack innate intelligence. One could write a rule that says, “send all PIP claims to our PIP specialist,” but this can create problems fast.

What if the PIP specialist starts getting bogged down with low-level PIP claims? There’s no business rule that can evaluate the relative complexity of a claim and divert simpler claims to other workers. This also makes it difficult to train or up-skill existing employees – there’s no easy way to gradually divert simpler or intermediate PIP claims to a promising adjuster. Lastly, this works against automation – you have to manually identify simpler claims before sending them to straight-through processing.

AI works better, because AI solutions understand:

  • When a claim needs specialized handling
  • Which agents have specialized expertise
  • Whether a claim is important enough that it needs to be bumped up the queue


In addition, AI solutions can arrive at these understandings in near real time – to triage the claim, make the assignment, and allow the adjuster to respond quickly.

How do AI solutions help with aligning claims?
AI solutions posses the features above, but how do they get there?

The key difference is that AI solutions learn with every engagement. When configuring a solution like Shift Claims Intake Decisions, claims administrators work with Shift to prioritize sending certain claims to certain employees – but this implementation doesn’t have to be static.

After running for a period of time, the solution might note that claims adjuster Y solves PIP claims 30% faster than average at a certain complexity level. This means that Y might become the additional PIP specialist, creating more bandwidth for the more senior employee.

S how does the AI understand complexity? At the beginning, adjusters will work with Shift to identify scenarios which represent complex claims. Over time, the AI may identify new scenarios, in which claims that might ordinarily have been referred to straight through processing come back with errors or requests for more information. These new scenarios can automatically be referred to more senior employees.

The result? AI solutions reduce or eliminate manual effort for administrators, while allowing front-line handlers and adjusters to address claims with greater accuracy and confidence in a shorter period of time. This translates directly into better customer experiences, driving increased retention and higher revenues.

For more information on Shift Claims Intake Decisions and how we can help align claims to adjusters – request a demo today.