Claims organizations are under constant pressure to modernize: move faster, reduce cost, improve customer experience, and adopt new technology. But as Krista Eger, VP of Product at Benekiva, explains in this Claimversation, many transformation efforts fail for a simple reason: they digitize broken processes instead of transforming them.
Technology will scale whatever you give it—good or bad. And in claims management, that distinction matters more than ever. View the conversation or read the recap below.
Many legacy claims processes weren't designed around customer outcomes or examiner efficiency. They were designed around:
When those same manual steps are recreated inside a claims platform, organizations end up hardcoding inefficiencies and locking in risk. Worse, they make future change exponentially harder.
"If a process needs a human to remember how it works, it's already broken."
— Krista Eger, VP of Product at Benekiva
Claims automation doesn't fix that problem—it accelerates it.
One of the most important distinctions from the conversation is the difference between digitization and transformation:
Digitization may improve speed. Transformation improves outcomes.
If customer experience doesn't improve or if claims examiners' work doesn't get easier, then nothing was truly transformed. The organization simply digitized a broken process.
The right order matters:
Transform first. Then digitize what you've transformed.
Krista shared several warning signs that a claims organization is digitizing instead of transforming. These red flags often show up during requirements gathering and system configuration:
To uncover whether a claims process truly belongs in a modern system, Krista recommends asking a simple but powerful set of questions:
If the answers aren't clear or can't be confidently explained, that step is a strong candidate for removal or redesign.
One of the biggest mistakes in claims transformation is treating it as something that happens to examiners instead of with them.
Claims examiners:
When examiners are involved early and treated as designers, not just recipients, adoption improves and outcomes follow.
Transformation isn't about replacing examiners. It's about elevating judgment and removing low-value, manual work like spreadsheets, re-keying data, and repetitive reviews.
If a claims organization can fix just one thing, Krista recommends starting with decisioning.
Unclear decision logic leads to:
When systems clearly define:
Everything changes. Claims move faster, errors decrease, examiners gain confidence, and supervisors focus on true exceptions—not routine work.
A transformed claims process should pass several practical tests:
If people are still relying on spreadsheets, workarounds, or asking for the "old way," the transformation isn't finished.
Claims transformation doesn't start with technology—it starts with understanding.
Don't automate your past. Slow down long enough to ask why. Design claims workflows around outcomes, not habits.
Every manual step should earn its place. Every rule should be intentional. And every process should make life easier—for the people doing the work and the people waiting on it.
Discover how Benekiva helps carriers transform—not just digitize—their claims operations.
