Like many industries, insurance is undergoing a digital transformation. While antiquated legacy systems have historically slowed carriers’ adoption of new technologies, we are now on the cusp of meaningful change.
Most carriers are implementing some form of AI to transform the insurance experience for employees—particularly in the claims process, which sits at the heart of this evolution. Over three-quarters (77%) of US insurance executives say their companies have deployed AI in some capacity, and 62% believe its competitive edge lies in high-volume tasks like claims processing and customer service, according to a 2025 report from Genpact.
Once burdened by paperwork, delays, and a lack of transparency, the claims journey is being reshaped by automation and AI. Some insurers report that AI-powered claims automation is reducing processing time by up to 70%, saving insurers an estimated $6.5 billion annually, according to a 2025 survey from CoinLaw. This transformation is about more than just efficiency—it’s about creating a better experience for employees and redefining the roles of carriers and brokers in a digital-first world.
Improving the claims experience
The claims process is one of the few areas in the customer journey that directly impacts employees. It can easily make or break their overall experience during an already sensitive time. Imagine losing a loved one, recovering from a devastating accident, or being diagnosed with a critical illness that keeps you out of work for several months—and then having to navigate a daunting claims process filled with excessive paperwork, long processing times, and limited visibility into claim status.
These challenges not only frustrate employees but also increase the administrative burden on HR teams and benefits managers, potentially jeopardizing broker-employer relationships.
On the other hand, working with carriers that offer a fast, accurate, efficient, and transparent claims process—with minimal or no paperwork—can help benefits brokers build trust and credibility with their clients. In a competitive landscape like the employee benefits industry, where benefits have become table stakes, brokers who work with carriers offering a truly streamlined, digital-first experience will stand out.
Here are five strategies with the greatest potential to transform the claims process:
1. Think digital
While most employees don’t expect an Amazon-like claims experience, they do expect some level of digitization. This can significantly reduce friction and errors while providing real-time access to their claims. Digital tools enable updates via portals, e-mail, and text notifications, giving employees visibility into their claims status.
2. Leverage AI to enhance, not replace human judgment
As in many industries, there are concerns about AI replacing humans. While those concerns are valid, insurance is an industry that requires a human touch that cannot be easily replicated or replaced. Today, AI is primarily used in a support role—assisting claims examiners by providing insights and automating routine tasks. This allows professionals to focus on relationship-building and complex decision-making. Many carriers will continue to rely on human judgment for final decisions, especially for complex claims.
3. Build unified claims platforms
Some of the most complex claims involve a single event that makes an employee eligible for multiple benefits. The best technology reduces workflow complexity. By integrating benefits into a unified claims platform, carriers can recognize overlapping coverages and treat them as a single event. This reduces the need for employees to file multiple claims and minimizes employer involvement, while also improving outcomes and reducing administrative complexity.
4. Always lead with empathy — especially in a digital world
No matter how far automation goes, maintaining human touchpoints and connections are essential. Personalized communication triggered by milestones or life events, along with access to claims experts, ensures employees receive the support and empathy they need during difficult times.
5. Meet employees where they are through mobile-first engagement
Most Americans own a smart phone and use it throughout the day—for reading, social media, web browsing, and bill payments. Employees expect mobile experiences that allow them to file claims, upload documents, and track progress—all from their phones. Real-time notifications and intuitive interfaces can significantly enhance engagement and satisfaction.
The next frontier: Preparing for the future
Many wonder what the next technology solution will be to further enhance the claims process. With the rapid pace of innovation, the future is already here. Though still in its early stages, artificial intelligence and advanced analytics are being used to detect fraud, forecast trends, and personalize offerings. These capabilities not only improve operational efficiency but also reduce costs and enable more tailored, customizable benefits for employees.
Technology is not just a tool—it’s a strategic enabler of better claims outcomes. By embracing innovation, brokers and employers can streamline operations, enhance employee satisfaction, and position themselves for long-term success.
Evan Scarponi is Head of Claims for Equitable’s Employee Benefits business.
Equitable is the brand name of Equitable Holdings, Inc. and its family of companies, including Equitable Financial Life Insurance Company (NY, NY) (Equitable Financial) and Equitable Financial Life Insurance Company of America (Equitable America), an Arizona stock corporation, issuers of annuity and life insurance products, and Equitable Distributors, LLC.Equitable Holdings, Inc. and its affiliates do not make any representations as to the accuracy, completeness or appropriateness of any part of any content hyperlinked to from this article. GE-8274395.1(08/25)(exp.08/29)
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