AI Adoption Linked to Higher Claims Performance
Claims leaders using predictive modeling and AI tools are seeing efficiency gains and faster claim closures.
Updated on Sept. 24, 2026 in Remote Work
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A 2026 benchmarking study from Rising Medical Solutions reveals that 41% of claims leaders now use AI and predictive modeling to manage workflows. These technologies are increasingly adopted by high-performing organizations to address heavy administrative and compliance burdens.
Why it matters
Administrative and compliance tasks hinder 85% of claims operations, creating a need for automated efficiencies to maintain throughput. Organizations that fail to assess these tech-driven outcomes risk falling behind peers who are using predictive models to boost closure rates.
A survey of 338 claims leaders shows 41% now utilize AI tools, with 58% of those users reporting improved frontline staff efficiency. However, 35% of adopters still have not assessed the specific effect of these tools on claim closure outcomes.
The players
Rising Medical Solutions
A medical management services provider that focuses on workers' compensation programs and cost-containment strategies.
The details
High-performing organizations are defined by the study as those closing at least 101 claims for every 100 received. These leaders use predictive modeling to automate routing and risk assessment, directly mitigating the administrative load that plagues the industry. While 50% of users report improved claim closure outcomes, the lack of performance tracking by over a quarter of firms suggests a significant gap in operational oversight.
Timeline
Survey responses were collected from November 2025 through January 2026.
The 2025 Workers' Compensation Benchmarking Study was released on September 24, 2026.
Market Landscape
The widespread adoption of predictive analytics follows a trend toward digitizing complex claims workflows to combat rising administrative overhead. This development marks a transition from manual processing to data-driven triage for organizations looking to improve claim closure ratios.
Operators should audit whether their current claims-management software provides measurable data on staff efficiency and closure outcomes. If internal tracking remains absent, prioritize implementing a performance-baseline assessment to justify future technology investments.
The takeaway
The gap between high-performing and lower-performing firms is increasingly defined by the utilization of predictive tools. Operators should immediately track the percentage of administrative time spent on compliance to determine if automation can reclaim capacity.
Further reading
For more on evolving workplace tools, visit the Remote Work section.
Source note: This article includes information reported by Business Insurance.
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