Are We Training Claims Adjusters or Claims Processors?

I started my career as a writer.

Not an insurance professional. Not an adjuster. A writer.

When I eventually took a chance on claims, I assumed I was changing careers completely. I was wrong. The more claims I handled, the more I realized there was a lot of journalism in adjusting.

A good journalist does not simply write down what people say. That is closer to a stenographer.

A journalist asks questions. Then asks another one when the first answer does not quite add up.

They look for inconsistencies. They consider the source. They separate facts that matter from facts that are just noise. They figure out what is missing. Eventually, they have to stop collecting information and decide what story the facts actually tell.

Claims adjusters do much of the same thing. Or at least they should.

Today, it has never been easier to keep a claim moving. Systems create activities. Diaries tell us when to look at the file again. Reports arrive electronically. Templates help create letters. Dashboards track performance. Artificial intelligence can summarize documents and organize information that once took an adjuster hours to work through.

All of that can be useful. But there is a downside if we are not careful.

A file can be very busy without actually going anywhere.

That raises a question the industry should be asking: Are we training claims adjusters, or are we training claims processors?

The Difference

A processor receives the police report and puts it in the file.

An adjuster reads it and notices the witness account does not match the insured’s statement.

A processor orders medical records.

An adjuster asks whether another six months of records will actually change the evaluation.

A processor receives an expert report and forwards it to defense counsel.

An adjuster asks whether the report answers the question we hired the expert to answer in the first place.

A processor completes the activity.

An adjuster asks what should happen next.

None of this means that processes are bad. They are certainly necessary. Claims organizations need consistency, documentation and regulatory compliance. Technology can make all of those things easier.

The problem comes when completing the process becomes confused with adjusting the claim.

The diary can tell an adjuster it is time to review the file. It cannot necessarily tell the adjuster what matters when they do.

Asking the Next Question

I learned this lesson early in my career.

I was taking a recorded statement from an insured and working my way through the questions I had been trained to ask. Like many new adjusters, I wanted to make sure I covered everything on my list.

At some point during the interview, the insured mentioned traveling back and forth to the airport.

I asked the question. I recorded the answer. Then I went to the next question on my list. What I didn’t do was stop and ask: Why were you going back and forth to the airport? How often? Were you transporting anyone? Was someone paying you? Was this related to a business?

As I later learned, the insured was operating a livery business while the vehicle was insured under a personal auto policy. What initially sounded like an ordinary answer potentially had significant coverage implications.

The script wasn’t the problem. I followed it too well. I was processing the interview instead of adjusting the claim.

Looking back, my old writing instincts should have kicked in. Forget the next question written on the page for a moment. Ask the next question raised by the answer.

That is a skill we need to make sure we continue teaching.

Activity Is Not the Same as Progress

Claims professionals today have no shortage of activity.

There are diaries to complete, emails to answer, reports to review, reserves to update, calls to return and litigation reports to read.

A file can contain hundreds or even thousands of pages. Yet sometimes only a handful of facts actually drive the outcome.

That is where judgment comes in. What fact changes liability? What piece of medical history changes the evaluation? What testimony changes the litigation strategy? What additional investigation is actually necessary? What information would cause me to change my mind? And perhaps most importantly: What are we waiting for?

That last question can be surprisingly revealing on an old claim.

If the answer is simply that another diary is coming due in 30 days, the file may be moving through a process without anyone really driving it toward an outcome.

Technology Should Provide More Time to Adjust

As artificial intelligence takes on more of the claims process, the question becomes what we want the adjuster doing with the time it gives back.

The NAIC’s surveys of private passenger auto and homeowners insurers found that 88% of responding auto insurers and 70% of responding homeowners insurers were using, planning to use, or exploring AI or machine learning models.

Yet the NAIC also makes an important point. Claims professionals continue to play a role in reviewing information and exercising judgment, and human oversight remains an important part of insurance decision-making.

That distinction matters.

If technology can summarize 500 pages of medical records in minutes, good.

If it can organize documents, identify dates, populate routine information and eliminate repetitive administrative work, even better.

Claims professionals should not spend their careers performing tasks that technology can perform faster and more consistently.

Swiss Re offers a real-world example. Its ClaimsGenAI initiative is designed to streamline corporate claims handling and automate time-consuming tasks while keeping human experts in control of decision-making.

That should be the goal. Freeing the adjuster from processing should create more time for adjusting.

The risk is allowing the opposite to happen: using increasingly sophisticated tools while gradually losing the ability to independently investigate, question and make decisions.

Leaders Have a Role, Too

There is another way we can unintentionally create processors. We give them the answer.

An adjuster walks into a supervisor’s office, or these days sends a message, and asks:

“What should I do?”

For a busy supervisor, providing the answer is efficient. The adjuster leaves. The supervisor gets back to work. The claim moves forward.

I was fortunate to have a manager earlier in my career who often took a different approach.

When I brought him a difficult claim and asked what I should do, he did not immediately give me the answer. Instead, he turned the question back on me.

“What do you think we should do?”

Then came the more important question.

“Why?”

I had to explain my recommendation. I had to point to the facts that supported it. I had to think about the weaknesses in my position and be prepared to explain why I still believed it was the right approach.

Sometimes he agreed with me. Sometimes the discussion led me somewhere else. But when I had thought through the issue and could support my recommendation, he gave me room to make the decision and move the claim forward.

That mattered.

He wasn’t just helping me resolve the claim sitting in front of us. He was teaching me how to handle the next one without him.

There is an important difference between giving an adjuster an answer and helping an adjuster arrive at one.

One gets the file off the supervisor’s desk. The other develops judgment. That takes more time today. It may save a lot of time tomorrow. And perhaps more importantly, it creates adjusters who eventually stop asking, “What should I do?”

Instead, they come to their manager and say: “Here’s what I think we should do, and here’s why.”

That is a very different claims professional.

Don’t Lose the Story

Claims technology is going to continue improving. AI will become more capable. More administrative work will be automated. Systems will get better at identifying information, creating activities and recommending next steps.

That is not something claims professionals should fear. It may actually create an opportunity to get back to the most interesting part of the profession. Thinking.

Someone still has to notice when the answers do not quite add up. Someone has to ask the second question. Someone has to determine which facts matter and which are noise. Someone has to decide when enough information is enough.

And eventually, someone has to make the call.

A stenographer can record the story.

The adjuster’s job is to figure out what the story means and decide what happens next.

Technology may become very good at telling us what happened in a claim.

The value of the adjuster will increasingly be determining what it means and what to do about it.

That’s not processing. That’s adjusting.

Casaleggio is the author of the Adjusting to Claims book series and Northeast regional director at MC Consultants. Email: chris.casaleggio@mcconsultants.com.