From Complexity to Opportunity: Dana Applegate on the Future of Claims Automation

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TL;DR:

• Claims management faces unique challenges due to its heavy reliance on contractual obligations and regulatory compliance.
• Automation in claims can streamline processes like invoice payments, fraud detection, and document organization, freeing up time for critical thinking.
• Implementing AI in insurance requires careful change management to address mistrust and ensure successful adoption by seasoned professionals.
• The balance of human insight and AI automation ensures empathy and accuracy in claims processing, improving customer experience.
• Leveraging automation can bridge the growing talent gap in the insurance industry, preserving institutional knowledge and enhancing scalability.

Before we dive into the key takeaways from this episode, be sure to catch the full episode here:

Meet Dana - Senior Vice President of Claims at Coaction Global

Dana Applegate oversees claims handling teams for domestic and international risks at Coaction Global and leads technical services such as litigation management, compliance, and claims transformation projects.

With 28 years in the insurance industry, Dana brings a unique blend of expertise in claims management and project strategy.

Her passion for problem-solving has driven her to innovate processes and embrace emerging technologies like AI to enhance operational efficiency.

Committed to advancing the industry, Dana focuses on fostering efficiency while maintaining the human touch in claims management.

Her forward-thinking approach ensures that Coaction Global stays at the forefront of technological advancements while delivering exceptional service.

Redefining Claims Management at Coaction Global

Dana Applegate oversees diverse claims handling teams and technical services, such as litigation management and compliance.

With nearly three decades of experience, Dana has witnessed the evolution of claims management and embraced innovative solutions to enhance efficiency.

“Efficiency comes from blending human insight with automation, not replacing it.” — Dana Applegate

Her unique background in project management complements her claims expertise, allowing her to break down large-scale challenges into actionable processes.

This approach is evident in her focus on integrating AI into claims workflows, reducing operational burdens, and enabling teams to focus on critical thinking.

Dana’s leadership at Coaction Global exemplifies how the insurance industry can redefine traditional practices, blending cutting-edge technology with a human-centered approach to deliver better results for policyholders and businesses alike.

Challenges in the Claims Process: From Complexity to Opportunity

The claims process is inherently complex, governed by contractual obligations and regulatory constraints.

Dana highlights how misconceptions about claims—such as expectations for instantaneous decisions—often add to these challenges.

The traditional approach is time-intensive, requiring meticulous documentation and thorough analysis, which can frustrate customers seeking quick resolutions.

Moreover, inefficiencies in document handling or communication delays exacerbate these issues, leading to mistrust and dissatisfaction. However, Dana views these complexities as opportunities for innovation.

By identifying bottlenecks—like repetitive tasks or disorganized document management—she demonstrates how streamlining processes can reduce cycle times and enhance trust.

This perspective shifts the narrative from enduring inefficiencies to exploring advancements, paving the way for modernized claims operations.

Automation’s Role in Modernizing Insurance Operations

Automation is transforming insurance operations by addressing inefficiencies in processes that were previously handled manually.

Dana underscores how tasks such as invoice payments, document organization, and fraud detection are now ripe for automation.

By integrating AI into insurance, companies can reduce manual administrative work, enhance accuracy, and accelerate cycle times.

For instance, automating the setup of claims files and extracting data from documents minimizes the reliance on human intervention for repetitive tasks.

This modernization not only improves operational efficiency but also frees up employees to focus on higher-value activities like critical analysis and customer interactions.

Dana’s approach at Coaction Global illustrates how automation can serve as a foundational step toward creating a more agile and scalable insurance industry.

Key Areas Ripe for AI and Automation in Claims

Certain aspects of the claims process are particularly suited for AI and automation.

Dana identifies invoice payments, fraud detection, and litigation management as prime examples of implementing AI-powered solutions in insurance.

These tasks often involve repetitive and structured workflows, making them ideal candidates for automation.

For instance, AI can assist in identifying red flags in fraud detection and connecting disparate data points to uncover suspicious patterns. Similarly, automation can streamline the creation and organization of claims files, ensuring that critical documents are accessible without delays.

By targeting these areas, insurers can achieve significant time savings and improve overall process efficiency.

Dana emphasizes that such advancements not only reduce operational costs but also contribute to better outcomes for both insurers and policyholders.

Balancing Human Insight and Automation for Better Outcomes

While automation offers immense potential, Dana stresses the importance of maintaining human oversight in claims management.

She likens AI to a new employee that requires guidance, training, and constant refinement to perform effectively.

Human insight remains critical in areas where empathy, judgment, and nuanced decision-making are essential, such as handling emotionally charged claims.

For example, understanding a customer’s frustration or addressing their concerns in real time often requires a human touch that automation cannot replicate.

Dana advocates for a collaborative approach where automation handles repetitive tasks, allowing employees to focus on high-value activities.

This balance ensures that claims processes are both efficient and empathetic, delivering superior outcomes for customers and maintaining trust in the system.

Overcoming Mistrust and Adopting New Technology

Adopting new technology in the insurance industry often encounters resistance, particularly from seasoned professionals accustomed to traditional methods.

“Adapting technology isn’t a quick fix—it requires time and iterative improvements.” — Ankur Patel

Dana acknowledges this mistrust and emphasizes the importance of clear communication about the benefits of AI automation in insurance. She highlights how showcasing tangible advantages—like reduced administrative burdens and more time for critical thinking—can help win over skeptics.

Change management strategies, such as involving employees in the implementation process and customizing solutions to their specific needs, are crucial.

Dana also suggests focusing on quick wins, like automating a heavily manual process, to demonstrate immediate value and build confidence.

By addressing concerns transparently and involving teams in the journey, organizations can foster a culture that embraces technological advancements.

Improving Customer Experience Through Smarter Claims Processes

Customer expectations in the insurance industry have evolved, with many demanding faster and more transparent claims resolutions.

Dana highlights how automation can enhance the customer experience by reducing cycle times and improving communication.

For example, integrating AI to organize and extract critical data from documents prevents delays caused by misplaced files. Additionally, offering customers choices, such as interacting with automated systems or human representatives, empowers them to engage in ways that suit their preferences.

Transparency is another key factor; involving customers in pilot programs or soliciting feedback on new technologies fosters trust.

By combining automation with thoughtful design, insurers can create seamless experiences that address common pain points and build long-term customer loyalty.

The Future of Claims: Bridging the Talent Gap with Technology

The insurance industry faces a growing talent gap as experienced professionals retire and fewer new entrants join the workforce.

Dana sees technology as a critical tool for addressing this challenge. By automating repetitive tasks, AI can alleviate the workload on smaller teams and preserve institutional knowledge through advanced systems.

Additionally, Dana envisions a future where retiring professionals take on advisory roles, teaching AI tools to replicate their expertise and mentoring new hires.

This approach not only bridges the talent gap but also ensures continuity and scalability.

By leveraging technology to support and enhance the workforce, the insurance industry can maintain its vital role in society while adapting to demographic shifts and evolving expectations.

Want to learn more about AI use in insurance? Check out this episode on insurance processes automation for unlocking efficiency while maintaining trust with Meredith Barnes Cook.