Infographic: AI in Claims Management

IBI's AI in Claims Management research examines how employers understand, experience, and respond to AI use by their disability insurance carriers and third-party administrators, using survey data from 502 HR and benefits decision-makers. The study assesses employer familiarity with vendor AI applications, comfort with automated claims adjudication and underwriting, data privacy concerns, and governance readiness, and identifies a significant gap between employer awareness and the protective steps most have actually taken.

Highlights from IBI's study:

• Employer familiarity with vendor AI is moderate to high: Over 80% can identify at least one AI application their carrier or TPA uses, with 56.8% recognizing claims adjudication, affecting benefit outcomes.

• Comfort is broad but conditional: 62% are comfortable with AI auto-adjudication, but 98% want safeguards, mainly human review of denials.

• Data privacy concerns are widespread: 55.8% worry about employee Protected Health Information (PHI) being used for AI training, regardless of overall AI comfort.

• An action gap exists: 72% have asked vendors about AI practices, but less than half have contractual provisions; PHI concern alone doesn't drive contractual action.

• Transparency cuts both ways: Vendors providing detailed disclosures make employers nearly three times more likely to want to prohibit AI, showing more info leads to stronger positions.

• Governance intent outpaces structure: 77% plan to include AI governance in RFPs, but only 7% have a cross-functional AI governance committee.