In the first of this three-part blog series, we explore Myth #1 – “AI replaces handlers” from our 10th March webinar: AI in Insurance Claims: Myths, Realities and the ExCo Gap watch it now.
Few topics in insurance generate as much debate as artificial intelligence (AI) in claims.
One of the first questions that inevitably arises is whether AI will replace claims handlers.
It’s an understandable concern. Automation has already transformed many operational processes across financial services, and AI capabilities are advancing at remarkable speed.
But according to the panel in the recent webinar AI in Insurance Claims: Myths, Realities and the ExCo Gap, that framing misses the point entirely.
The real change underway is not about replacing claims professionals. It’s about fundamentally changing how claims work gets done.
Sprout.ai CEO Roi Amir explained that the biggest impact of AI today is on the operational work that sits around the core claims decision. Large volumes of claims involve time-consuming tasks such as document ingestion, extracting data from forms, standardizing information and performing the initial triage of cases.
These are precisely the areas where AI excels.
“We can automate the ingestion of data, the intake of information, and the initial processing of claims,” Amir explained during the webinar. “At large scale, AI is very good at doing that.”
Removing this administrative friction changes the nature of the claims role. Instead of spending time processing paperwork or searching for information, handlers can focus on the parts of claims that truly require expertise: interpreting complex policies, managing difficult cases and delivering the right outcomes for customers.
What has changed dramatically in the past two years is the sophistication of AI’s capabilities. Tasks that were previously considered too complex for automation are now becoming possible. AI systems can analyze policy wording, identify relevant clauses, flag potential fraud indicators and even support cost estimation for repairs.
Yet despite these advances, the panel emphasized that human oversight remains essential.
Claims decisions carry significant financial, regulatory and customer implications. Ultimately, the responsibility for those decisions still rests with insurers and the professionals who manage the claims process.
“Accountability at the end of the day lies with the claims handler or the insurer,” Amir said.
The most successful implementations therefore treat AI as a partner rather than a replacement.
In one example discussed during the webinar, an insurer using AI for high-volume health reimbursement claims was able to automate around 70% of cases through straight-through processing. The result was not only faster decisions but a measurable improvement in customer experience, including a 19% increase in satisfaction and a 23% reduction in turnaround time.
In another case, AI-assisted policy analysis helped property claims adjusters make coverage decisions significantly faster while improving accuracy.
These outcomes highlight the real opportunity in AI adoption. When administrative workload is reduced, claims professionals can spend more time applying judgement, empathy and expertise where it matters most.
The shift mirrors what is happening across many industries. AI does not eliminate expertise. Instead, it amplifies it.
As Roi Amir quoted from Harvard Business School professor Karim Lakhani during the discussion:
“AI will not replace humans. But humans with AI will replace those who don’t adopt it.”
For insurers, the question is no longer whether AI will reshape claims operations. The real question is how quickly organizations can adapt their processes, teams and technology to take advantage of the opportunity.
To learn more:
Watch now: AI in Insurance Claims: Myths, Realities and the ExCo Gap
Watch now: 5 Golden rules for trustworthy AI in policy coverage checking with Bernie Camus