Artificial intelligence (AI) is one of the most talked-about innovations in insurance and legal services today. Promises of faster claims, reduced costs, and smarter insights have sparked both excitement and skepticism. But when it comes to medical record retrieval and analysis—a critical part of claims and litigation—the question remains: what’s real, and what’s just hype?
At Ontellus, we see AI as a powerful tool, but one that must be implemented with security, compliance, and practical outcomes in mind. Let’s separate fact from fiction.
Hype: AI Will Replace Human Expertise in Claims Processing
One of the biggest misconceptions about AI in claims is the idea that machines will fully replace adjusters, attorneys, or medical experts. However, traditional AI—rule-based, data-dependent systems—struggles with flexibility and cannot effectively handle exceptions in the claims management process. The reality is that each claim involves sensitive medical, legal, and regulatory nuances that AI alone cannot navigate.
Reality: AI Supports—but Doesn’t Replace
Medical records are complex and understanding them requires medical-legal expertise—not just pattern recognition. In practice, AI tools are used to assist with claims processing by sorting and summarizing information, but only trained professionals can apply judgment, context, and strategic insight to ensure proper outcomes.
In other words, AI may highlight patterns and help determine which records or facts are relevant, but human experts deliver the judgment needed for litigation and settlement by making the final determination. While automation can significantly accelerate review, it still requires human oversight to validate findings and ensure accuracy.
Hype: AI Delivers Instant, Error-Free Results in Claims Processing
Another misconception about AI is that it produces flawless results almost instantaneously. In reality, AI models are only as good as the data they’re trained on. Investing in high-quality training data is essential for accurate claims processing, as robust and realistic datasets help AI models make better decisions and avoid costly errors. But incomplete records, inconsistent formats, unstructured data, and human error in medical documentation can limit accuracy. More importantly, medical records are highly nuanced. AI can misinterpret terminology, overlook context, or flag irrelevant details.
Reality: AI Can Automate Repetitive, Manual Work
AI is excellent for reducing repetitive, administrative tasks. In claims processing, this means automating tasks like:
- Record classification and indexing – AI can recognize file types, tag medical terminology, and organize thousands of pages faster than a human.
- Data extraction and data capture – Key facts such as dates of service, providers, and diagnosis codes can be pulled automatically from each document to speed up review.
- Duplicate detection – AI can flag redundant records or documents, saving hours of manual cross-checking.
- Optical character recognition (OCR) – AI uses optical character recognition to automate the interpretation and categorization of handwritten notes and other unstructured documents.
By streamlining these repetitive, routine tasks, AI reduces manual tasks and allows claims handlers to dedicate their expertise to higher-value work instead of routine or manual tasks, improving overall workflow efficiency.
Ontellus’ Take: Secure, Compliant AI Adoption
At Ontellus, we believe the future of claims processing lies in practical, secure AI adoption. That means leveraging AI where it adds value—reducing turnaround times, improving accuracy in data organization, and enabling faster access to information—while never compromising compliance or professional expertise.
Our commitment to HIPAA-compliant processes, encrypted file transfer, and seamless collaboration ensures that AI is a tool for efficiency. We see AI as an enabler, not a replacement, for the human expertise that drives better case outcomes.
With Ontellus’ secure record retrieval and expert partnerships, claims organizations can embrace AI confidently—stripping away the hype and unlocking real, measurable value.
Topics: Ontellus Insight
