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You Know Who Hates AI? Insurance Claims Adjusters

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Re: You Know Who Hates AI? Insurance Claims Adjusters

#61

Post by dpoloncsak »

antasvara wrote: post #49
glimshe wrote: post #5

Ultimately this isn't "AI's fault". As the article points out, clueless executives who don't understand the capabilities and limitations of specific LLMs push the technology on workers so they can say they are "using AI to improve efficiency".

I don't know, it feels like "reading a claims summary and classifying the type of claim" should be the bread and butter LLM use case? Not that executives are blameless for pushing AI everywhere, but we should also be able to "blame" AI for doing poorly at a task it's supposed to be good at.

A computer can never be held accountable, therefore a computer must never make a management decision.

You can't 'blame' the AI, as it can't be held accountable.

Re: You Know Who Hates AI? Insurance Claims Adjusters

#63

Post by wellpast »

Two months ago I had a water pipe burst in my house.

Now I am in the claims process with the large insurance co., using Claude to basically run my side of the claim — reading the policy, organizing and filing the ALE receipt scans, reading and notifying me of messages from the agents, calling out when they are delaying too much or not fulfilling their promises, challenging their decisions on what to cover based on the policy, keeping a log of all of our correspondences, logging work estimates and invoices, I cant imagine doing all this tedious work myself—w/o Claude I’d probably just rollover fatigued.

Does my adjuster like this? On the one hand, I’m giving her incredibly tidy and documented receipts and logs, which I am sure is saving her time.

On the other hand, Claude is calling out her BS and delays, which have been atrocious—so much so that Claude is now adamant that she has gone too far and that I should be filing a complaint with the state insurance bureau.

Re: You Know Who Hates AI? Insurance Claims Adjusters

#64

Post by WarmWash »

antasvara wrote: post #49
glimshe wrote: post #5

Ultimately this isn't "AI's fault". As the article points out, clueless executives who don't understand the capabilities and limitations of specific LLMs push the technology on workers so they can say they are "using AI to improve efficiency".

I don't know, it feels like "reading a claims summary and classifying the type of claim" should be the bread and butter LLM use case? Not that executives are blameless for pushing AI everywhere, but we should also be able to "blame" AI for doing poorly at a task it's supposed to be good at.

Not that it is necessarily the case here, but when execs go "AI shopping" they have absolutely _zero_ idea that there are basically 3-4 SOTA models, thousands of smaller models, and then an uncountable number of wrappers on whatever underlying model. The AI landscape that is totally familiar to us is covered in shroud for them.

So they Google "Insurance claim AI tool", land on a vibecoded SaaS that is just a wrapper on a pocket Chinese model spun as "your next insurance pro", and then are getting the whole department on some lone 19 yr olds weekend project.

Re: You Know Who Hates AI? Insurance Claims Adjusters

#66

Post by WarmWash »

seethishat wrote: post #37
hilariously wrote: post #15

Earlier quoted context omitted.

You should. It's their fault for picking a bad vendor. It's their fault for not finding someone with taste to solve the problem. Fundamentally its their business, pretending you can blame someone else for your ultimate accountability is stupid. Nobody is forcing you to take poison, and saying "Well Microsoft promised me it isn't poison!!!" at this point, decades into it selling poison, doesn't make much sense.

They didn't pick the bad vendor, the herd did. They all go to the same conferences, attend the same vendor lunches and buy the same garbage. And today, most of the IT managers are not technical at all. They have art degrees and have never been technology practitioners. Literally anyone off the street can be a "decision maker" in technology today. Just buy what everyone else is buying and collect a huge paycheck while…

My previous landlord was the IT manager of [big bank everyone would recognize] at their headquarters.

When he asked me to email him scans of a bunch of personal documents, I asked him for his PGP key.

..."What's that?"

Re: You Know Who Hates AI? Insurance Claims Adjusters

#67

Post by cael450 »

My wife works in autism services. Insurance companies are the bane of her existence. Every six months (sometimes less), she has to write a huge report justifying services. These reports are frequently over 100 pages and she is only slotted so much time to do it, so she ends up doing a ton of unpaid work. The entire business model is to drown the practitioner in paperwork then use “peer reviewers” who are nurses that don’t know anything about the treatment to deny claims then waste the practitioner’s time on appeals in the hopes that people will give up. AI has obviously made this process easier and the insurance companies absolutely hate it.

People have no idea how inefficient the U.S.’s healthcare system is. And it isn’t just the private companies. A ton of states purposefully overburden and underfund their Medicaid systems for ideological reasons. Then the private insurance companies adopt the same practices later.

Re: You Know Who Hates AI? Insurance Claims Adjusters

#68

Post by estearum »

jordanb wrote: post #57
colechristensen wrote: post #54

Earlier quoted context omitted.

I knew a guy who would buy three different kinds of a thing and return the two he didn't like... regularly. A small number of return abusers ruin things for everybody. Then again my last two online purchases, a pair of shoes arrived stained with somebody else's socks in the box and a cordless vacuum arrived with a mismatched brush head for a different model.

The thing is this was the pitch for buying clothes online: worried it won't fit? Just return it. No questions asked! We'll even pay return shipping! It's interesting how companies are now redefining things they explicitly encouraged their customers to do as "abuse."

The GP described it as abuse. That's not evidence of companies calling it abuse. As you say, this is basically intrinsic to the deal of buying clothes/shoes/etc online and obviously online retailers know that and accept it, or else they would not allow it (and in turn would not exist as businesses).

Re: You Know Who Hates AI? Insurance Claims Adjusters

#69

Post by estearum »

WarmWash wrote: post #60
colechristensen wrote: post #54

Earlier quoted context omitted.

I knew a guy who would buy three different kinds of a thing and return the two he didn't like... regularly. A small number of return abusers ruin things for everybody. Then again my last two online purchases, a pair of shoes arrived stained with somebody else's socks in the box and a cordless vacuum arrived with a mismatched brush head for a different model.

It's even worse than that, because they are adamant that they aren't abusing the system, and insist that if they didn't want people doing it, they would stop taking returns.

The behavior described in the immediately above comment (ordering multiples and returning ones you don't like) is not abuse. The behavior described above that (lying about a defective item) is abuse.

Dealing with returns is the tradeoff that online sellers make in order not to put a store in every city or to deal with retail arrangements.

Re: You Know Who Hates AI? Insurance Claims Adjusters

#70

Post by voncheese »

dpoloncsak wrote: post #61
antasvara wrote: post #49

Earlier quoted context omitted.

I don't know, it feels like "reading a claims summary and classifying the type of claim" should be the bread and butter LLM use case? Not that executives are blameless for pushing AI everywhere, but we should also be able to "blame" AI for doing poorly at a task it's supposed to be good at.

A computer can never be held accountable, therefore a computer must never make a management decision. You can't 'blame' the AI, as it can't be held accountable.

The interesting thing about AI v. other disruptive technologies (like the internet, steam engine, etc), is that AI has been personified both by the manufacturers of it (Anthropic being the most blatant by using a human name for its product) and users.

That makes it way more likely that people blame AI (doesn't make it right by any means, but does mean that the actual blame gets diffused even more).

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