Perspectives from more than 20 life, annuity, health, final expense, and living benefits experts — from Tier 1 carriers to fraternals — on the future of claims.
When carriers deliver on their promises through thoughtful claims, it can change the trajectory of someone's life. Yet across the industry, claims teams sit at the intersection of grief, urgency, regulation, and complexity, managing systems built decades apart and processes designed around human workarounds rather than human outcomes.
This report compiles perspectives from claims examiners, claims leaders, executives, consultants, system integrators, and technology partners across the industry. Together, they paint a clear picture: claims are at an inflection point.
"The claims process is backwards today. It puts the heaviest burden on the person least equipped to carry it — the beneficiary — and technology should reverse that burden."— Rob Strange, Sr. Director, Client Success, Transformation, & ACT Strategy at Evadata
From the outside, claims are often seen as administrative — necessary, costly, operational. The opposite couldn't be more true. Across interviews, several critical themes surfaced again and again.
Examiners must navigate systems built decades apart, with rules varying by state and product, often relying on manual workarounds.
Many claims still arrive via fax. Even "digital" FNOLs often mean static PDFs without automation, re-keying data introduces risk and wastes time.
Volatile rules, daily rate changes, and state-by-state requirements can halt automation at the finish line.
Claims teams don't burn out because they care too much. They burn out because the work is harder than it needs to be.
The report envisions a world where claims are proactive — where carriers reach out first, technology reverses the burden on beneficiaries, and straight-through processing becomes the default.
Imagine carriers reaching out first: "We are so sorry for your loss. Here's how you can get started when you're ready."
Simple claims validated automatically with external data sources, paid faster with fewer touchpoints.
Technology that gives time back — reducing the 9-screen shuffle and freeing examiners for meaningful work.
AI that assists — summarizing records, triaging claims, identifying gaps — without replacing human judgment.
"AI cannot replace compassion and empathy. When you answer that phone, AI can't hear the silence. AI can't hear you crying. That's where we step in."
— Kristen Crook, Director of Customer Success at Benekiva
The report explores claims transformation through four lenses: company-wide takeaways, executive focuses, operations and technology, and claims leader strategies. Key insights include:
Whether you're a claims examiner, operations leader, or executive, this report provides actionable insights to guide your transformation journey.
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