Claims generate an abundance of data. But numbers alone are just, well, numbers. You have to figure out what it means – and put it to good use.

Artificial intelligence combined with big data can identify subtle but important patterns to guide decision-making. You’ll be able to respond faster, allocate resources better – and even prevent similar claims altogether.

What can you pull out of your claims data? Plenty! Claims data can be used to identify:

  • Complex claims. Forecast how severe the loss will be for each claim, and flag costly and complex cases for early intervention. Complicated claims can be assigned to the most experienced adjusters and routine claims to less experienced adjusters – or even processed automatically – for the best use of resources.
  • Fraud. Calculate the degree of fraud potential, and identify early warning signs so those claims can be quickly referred to an investigator and/or medical evaluator.
  • Litigation potential. Use location, attorney involvement, and other criteria to determine which claims are likely to litigate so defense attorneys can immediately start building a case.
  • Medical management. Look beyond the reported injury to identify which claims need further investigation – by an independent medical evaluation, nurse case manager, pharmacy review, or other healthcare professional – to determine if treatment is appropriate and if other things can be done to improve the claim outcome.
  • Performance levels. Use important indicators such as lag time, litigation rates, average claim duration, severity, closing ratio, or aged-claim counts to determine how well your claims program is performing.
  • Priorities. With an estimated 20% of conditions driving 80% of claims costs, data can help determine which claims are in that critical 20% to focus on first for maximum impact.

With the right technology, you can take advantage of all the claims data you’ve been collecting by transforming data into insights that will help you make better decisions, reduce cycle time, and allocate resources more effectively. And that can make for some pretty impressive results.

To learn more about managing claims effectively, download our free e-book, Claim Success: How to Achieve Excellence in Claims Management.

Guide to RMIS