Why Insurance CIOs and CTOs Must Act on AI in Claims Now

AI is shaping the way insurance carriers handle claims. The technology exists, and it’s ready to use. The question is whether your organization is.

Technology leaders are still being asked to evaluate, assess, and design frameworks for AI adoption. In 2025, the companies that lead are the ones who started building or implementing AI technology into their insurance claims operations. The ones who waited are left catching up.

This blog focuses on the steps Chief Information Officers (CIOs) and Chief Technology Officers (CTOs) can take to bring AI into claims. Not in the future, but now.

Action Beats Lengthy Claims AI Strategy

Across the industry, most teams are stuck in planning mode. CIOs and CTOs feel the pressure to “get AI right,” so they spend six months building a plan. Then another six months validating it. Then twelve months on procurement.

That’s two full years before you see any measurable results.

The truth is, most of the questions about value, feasibility, and risk can be answered through small, practical deployments. You don’t need a 40-slide strategy deck to test one claims workflow. You need one team, one problem, and a clear line to results.

The Value of Fast, Focused Claims AI Pilots

In a legacy environment, launching something new takes months or years. That mindset doesn’t work anymore.

Most of the value we’ve seen from AI in insurance claims has come from focused deployments with a clear outcome. For example:

• Let the piloted tool assign claims to adjusters based on complexity and workload
• Let it calculate reserves when the data is already available
• Let it send reminders when follow-up is needed
  

Small pilots like auto-triage, reserve calculation, or auto-reminders aren’t major system changes. They’re small, targeted improvements that reduce manual work and return time to your team. 

The value of running focused pilots comes from two places: the immediate gains from reducing manual work, and the insight you get into how your systems, data, and teams respond. You see what works, what doesn’t, and where to go next. That kind of clarity doesn’t come from planning, it comes from doing.

Partner With Claims Leaders, Not Just the IT Team

In too many organizations, AI still sits within the technology group, isolated from claims operations.

That’s a mistake.

The people closest to the work are claims adjusters and leaders. They know where the blockers are. They know where they lose time and what creates overhead. Sit with them. Watch the process. Ask simple questions:

• Where are inefficiencies slowing us down?
• Which workflows frustrate employees or customers?
• What decisions could be faster or better with AI?
  

This kind of collaboration keeps the work tied to real outcomes. It makes sure you’re solving business problems, not chasing ideas. It also positions the CIO/CTO as a strategic enabler, not just a technology provider.

How to Measure ROI From AI in Insurance Claims

Once a pilot is live, what matters most is how you measure and present the impact.

You’re not proving that the AI you implemented is interesting. You’re showing that it works. That it saves time, reduces overhead, and improves how work gets done. 

Measure the change you see in cost per claim, the time it takes to resolve common scenarios, and the number of claims an adjuster can handle in a day.

Those are the numbers that matter to your CEO and your board. They’re also the ones that help build internal momentum to scale.

One successful pilot won’t just give you results, it gives you a story. A reason to keep the project going. Something real to point to when you ask for time, budget, or buy-in. And over time, those stories add up. They turn isolated wins into a stronger operating model.

The business case for implementing AI into your claims operations shouldn’t be theoretical. It should come from your own data, from work already done, and from impact already shown.

The Risk of Waiting: Claims AI Adoption Increases Competitive Advantage 

This year, we’re seeing claims organizations move fast. Not only because of the hype. It’s because the technology is here, it works, and it can be valuable right now.

Staffing is difficult. Adjuster burnout and dropout is increasing dramatically. Customer expectations are growing. Claims teams are being asked to handle more claims with fewer resources. Using technology that helps with that is unavoidable.

When you wait, you don’t just delay benefits, you fall behind. Teams that work with automation daily will be faster, more accurate, and better at serving policyholders. And the longer you wait, the harder it gets to bridge that gap.

At some point, the cost of staying where you are becomes greater than the cost of change. Most companies won’t realize they’ve passed that point until it’s too late to catch up—by then, customers will have already switched to carriers who respond faster, resolve claims quicker, and do it all with less friction. Often, with a click.

Clive™: The Multi-Agent AI Claims Expert, Built to Deliver Fast Results 

At Five Sigma, we built Clive to help claim teams move quickly—from first pilot to long-term transformation. He’s designed specifically for claims, with a clear focus on results: faster workflows, less manual effort, and better outcomes for both adjusters and policyholders.

Clive is a multi-agent AI claims expert. He works on top of any existing system to automate routine tasks, plan next steps based on your SOPs, and move claims forward without waiting on manual input. Each agent handles a specific part of the process—intake, triage, coverage, communication, fraud checks, compliance, settlement, and more.

You don’t have to adopt everything at once. Many of our customers start by deploying a single agent to test one use case. As they begin to see value—shorter cycle times, reduced overhead, fewer errors—they scale. Clive is built to support that approach.

We work side by side with your team to identify high-impact areas, plug into existing workflows, and accelerate time-to-value. You don’t have to choose between practicality and innovation. Clive delivers measurable ROI early, while setting you up for broader change down the line.

Whether the goal is to reduce adjuster workload, improve decision quality, or find new operational efficiencies, Clive ensures that each step forward delivers something that matters to the business.

How to Drive Fast, Sustainable Claims Impact

If you’re in charge of technology, here’s what I would do:

• Pick a clear use case in claims where automation will save time
• Involve claims leadership from day one
• Run a short pilot that gives you results in 30 days
• Track the impact in hours, handoffs, and resolution time
• Use the results to expand
  

You don’t need to wait for everything to align. You need to create a small win. Then another…

Clive can help you get there, and we’re ready to support you at every step.