In insurance, the claims process is the real “moment of truth.” It's when customers find out if their insurer is truly there for them. They don’t just want fair treatment—they also expect their claims to be handled quickly and easily. But the reality? Claims often take way too long because of outdated, clunky processes. And the growing tsunami of data needed to adjust a claim can create information overload for an adjuster.
Today’s customers expect real-time service in all aspects of their lives, and that includes insurance claims. It's not just about a quick FNOL—it’s about resolving the full claim quickly and accurately. Faster claims result in higher customer satisfaction and loyalty, which in a competitive market is critical.
In a recent Celent study of automobile claimants, 68% of those who said their claim closed quickly also said they loved their insurer. And half of those who said they loved their insurer said that they loved them so much, they would stay even if it cost more. So, closing a claim quickly has implications beyond the actual cost of the claim. Of course, speed isn’t just about customer delight; it also drives cost efficiency and operational agility.
But behind the scenes, adjusters still face delays. They’re forced to pull information from numerous sources—weather data, accident reports, fraud solutions, medical reviews, telematics, and more. At the same time, claim complexity is rising. Catastrophes, social inflation, and emerging risks like cyber threats require insurers to assess a wider range of data faster than ever. Modern claims processes must strike a balance between speed and accuracy, using technology to manage complexity without sacrificing quality. For complex claims like workers’ comp or commercial property, the result is information overload and inefficiency.
A better approach? A unified claims workbench that integrates systems and data into a single, intelligent interface. While claims administration systems do a terrific job of documenting the case, setting reserves, and authorizing payments, claims adjusters need more.
What is a claims workbench?
Fundamentally, a claims workbench serves as a central hub for all claims activities, offering a suite of tools designed to automate and streamline the process. This includes advanced analytics for claim assessment, workflow management to ensure tasks are completed on time, and integrated communication tools for seamless collaboration. The right workbench can dramatically improve decision-making accuracy and operational effectiveness and efficiency—providing contextual guidance, supporting decision-making, and automating routine steps.
The need for a claims workbench is not one-size-fits-all. In life insurance, AI can assist in automating benefit verification and cause-of-death validations. In P&C, especially commercial auto or homeowners, AI can quickly assess damage using image recognition and triage claims. Personal lines benefit from self-service FNOL and AI-driven estimates, while commercial lines often require orchestrated workflows that pull in regulatory, environmental, and third-party data. A workbench enables adjusters across all these sectors to access the tools they need in one place.
Whether integrated into a modern core system or layered on top of a legacy platform, a workbench acts as a unifying layer that enhances, not replaces, existing infrastructure. It delivers fast access to the right tools and insights no matter how simple or complex the claim. In short, a claims workbench becomes an intelligent co-pilot, enabling more informed, efficient, and consistent claims outcomes—especially as the volume and complexity of claims continue to grow.
Not all workbenches are created equal. The most effective ones share these critical features:
Document extraction and data ingestion: extracts relevant data from a variety of document types and populates the workbench with that data.
Context-aware automation: Recommends next best actions based on real-time data.
Decision support: Tools to help with decisions such as complexity scoring, adjuster assignment, litigation indications, identification of subrogation potential and others.
Document summarization: Uses AI to condense long or multiple documents like medical records, police reports, or repair invoices into actionable insights.
Document creation and notes. Document creation tools allow the adjuster to easily create outbound correspondence where needed.
Role-based interfaces: Tailored dashboards for adjusters, supervisors, vendors, and legal.
Collaboration tools: Real-time coordination across functions and stakeholders.
Private AI and LLMs: Trained on proprietary claims data for secure, contextual automation.
AI in claims
AI is already transforming the claims process: from image analysis and fraud detection to automated document summarization and generative customer communication capabilities. AI-driven systems can automate the FNOL process, enabling quicker claim initiation and reducing the need for manual input from customers and agents.
Computer vision and image recognition technologies are helping insurers quickly assess damage to vehicles, homes, and businesses, improving the accuracy and speed of estimates. AI is also being used to flag suspicious claims. By analyzing vast amounts of historical data, AI can spot patterns that indicate potential fraud, allowing insurers to take preventative measures. And with AI, insurers can more effectively distribute workloads across claims adjusters, optimizing their time and ensuring that high-priority claims are handled swiftly.
Private AI, in particular, plays a key role by ensuring that sensitive customer and claim data stays secure while powering personalized, context-rich automation.
These innovations are already driving measurable improvements in speed, accuracy, and efficiency. For instance PwC uses a claims workbench to power its claims management services, with outsourced claims handling arrangements across several lines of business. The solution increases claims handling efficiency by 30%, resulting in faster claim resolution for claimants and their families.
These current uses of AI demonstrate the significant improvements already being made to the claims process. However, as technology continues to advance, the possibilities for more sophisticated applications of AI in claims are vast. Generative AI and agentic AI will likely become critical components of the claims process. Summarizing medical documents, automating the creation of communications materials, and providing recommendations on next steps are all gen AI use cases in production today.
And agentic AI could revolutionize claims by acting as an autonomous claims agent. For certain types of claims, AI could manage the entire process—from start to finish—automatically processing the claim, analyzing data, and making decisions without human involvement. This would significantly reduce processing times for straightforward claims and free up adjusters to focus on more complex cases.
Choosing the right workbench
However, despite the advances in automation and AI, the human element in claims processing remains crucial. Adjusters and claims pros bring judgment, empathy, and negotiation skills that machines just can’t replicate—especially when it comes to complicated or emotional claims. For example, a claim involving severe damage to a home or injury will need a human adjuster who can assess the situation with empathy and provide clear, compassionate communication to the policyholder.
So even though there is no “one-size-fits-all” claims workbench solution, insurers can take comfort in the fact that there are options to fit almost any set of requirements. An insurer seeking a new claims workbench should begin the process by looking inward. Every insurer has its own unique mix of lines of business, geography, staff capabilities, business objectives, and financial resources. Some have a greater need for process efficiency; some need enhanced decision support. These needs and the organization’s risk appetite will influence the list of vendors to be considered.
Some vendors are a better fit for an insurance company with a large IT group that is deeply proficient with the most modern platforms and tools. Other vendors are better suited for an insurer with a small IT team that wants the vendor to take a leading role in maintaining and supporting its applications.
We recommend that insurers looking for a claims workbench system narrow their choices by focusing on four areas:
Functionality needed and available out of the box for the lines of business and states desired. Focus on your actual business objectives. If your goal is efficiency, place a higher weight on those features. If your goal is decision making, look at what is in production and what is on the road map.
Vendor stability, knowledge, and investment in the solution. Some of these providers are established vendors. You’ll want to be sure they’re investing in expanding the solution. Some of these vendors are startups. Look at their funding, their momentum, and assess their likely market success.
Technology. This includes the integration framework, overall architecture, and the configuration tools and environment.
Implementation and support capabilities and experience. Look for methodology to help extract your claims processes and tools. Much of this is likely being done manually by your claims adjusters.
The future of claims is about more than speed. It’s about better decisions, less friction, and more empathetic experiences. A claims workbench is the linchpin—bringing together AI, automation, and human judgment in a single environment that supports adjusters and delights policyholders. Insurers that act now can reduce costs, improve cycle times, and increase retention while empowering their teams with tools built for modern complexity.
The claims process isn’t broken—but it is overdue for reinvention. The workbench is a step in the right direction.
If you’re interested in learning more about claims workbenches, or want help choosing one, please reach out to your account executive or info@celent.com. We’d be happy to help.
