
Michael Krikheli
Co-Founder & CTO of Five Sigma
Michael leads the development of advanced claims management products powered by data, analytics, and AI. With over a decade of experience in software engineering and team leadership, Michael excels in designing, building, and scaling innovative technologies that solve complex, real-world challenges.
6 MINUTE READ
The term “artificial intelligence” often conjures up images of futuristic robots mimicking human behavior and thought process. Yet, for many skeptics, AI is reduced to something far less glamorous and much more simplistic: a machine predicting the next word (or token) in a sentence, with no actual intelligence. However, this simplistic narrow perspective misses how AI’s ability to process and analyze vast amounts of information can drive sophisticated outcomes.
Insurance claims management is an example of an industry where the implementation of AI can drive significant change. While claims management workflows can be broken down into seemingly simple and straightforward tasks – filing reports, entering data, or communicating with policyholders – as a whole, the process is remarkably intricate, requiring coordination, decision-making, and speed, often under high-pressure circumstances.
AI integrates various steps of the claims process—such as data entry, communication, and decision-making—into a unified workflow, ensuring efficiency and smooth collaboration across all parts of the operation.
Simple Building Blocks Create Sophisticated Claims Management Workflows
Nature offers countless examples of how simplicity gives rise to sophistication. Consider the mesmerizing flight patterns of bird flocks: each bird follows simple rules—stay close to neighbors, align direction, and avoid collisions. Yet, these straightforward principles create breathtakingly coordinated movements that appear almost choreographed, showcasing how simple interactions can lead to extraordinary outcomes.
This natural principle also applies to AI models, where simple mechanisms build toward sophisticated and impactful outcomes. While fundamentally their function is to predict the next word, the cumulative impact of this simple step generates increasingly valuable outputs.
The same applies to claims management. Routine tasks like capturing data during First Notice of Loss (FNOL) or verifying documents may appear straightforward. But these tasks, when interconnected, form workflows that influence every downstream process, from liability assessment to payment issuance. A single error at the initial stage can disrupt the entire claim’s lifecycle. On the other hand, accuracy throughout the claim’s life cycle minimizes delays, improves decision-making, and reduces costs like Loss Adjustment Expenses (LAE). By harnessing AI, insurers can turn these interconnected workflows into well-oiled mechanisms, ensuring optimal, accurate results.
Bridging the Gap between Routine Tasks and Strategic Thinking in Claims Management with AI
In claims management, tasks range from simple, repetitive actions to high-stakes decision-making. This dual nature is mirrored in how humans process information: some tasks are what we call “system 1” – automatic and intuitive, like moving a leg up down in order to make a step, or moving the knuckles in a synchronized way as I’m writing this blog. Other tasks we call “system 2” – those require deliberate thought and analysis, involve reasoning and problem-solving, such as strategizing or solving complex math problems.
Claims workflows involve a balance between routine activities, such as logging claim details or scanning documents, and strategic responsibilities like assessing liability or planning optimal resolutions. Both are essential, and the balance between them is crucial for efficient claims handling.
Modern AI models are excelling in both arenas. Models such as GPT-o1 or Google Gemini 2 can handle “system 1” tasks like voice transcription and data extraction while also supporting “system 2” tasks like contextual analysis and decision planning. Compound AI technology, which combines multiple AI systems to handle both routine automation and advanced problem-solving, brings these capabilities together, transitioning seamlessly between simple document processing and sophisticated reasoning, enabling insurers to meet the demands of efficiency and accuracy.
AI-driven claims management systems, especially those using compound AI technology, are stepping in to optimize these connections, not just by automating individual tasks but by orchestrating how they interact, transforming fragmented processes into cohesive workflows.
Clive™ AI: Navigating Claims Management Complexity with Refreshing Simplicity
Clive, the insurance industry’s first AI Claims Adjuster, is the embodiment of simple processes that create incredible outcomes.
Developed by Five Sigma, a pioneer claims AI insurtech, Clive seamlessly integrates with any existing claims management systems (CMS), adding advanced AI and Automation capabilities to any claims operations, without the need for costly overhauls.
Clive is built on the principle of compound AI technology. Combined with Five Sigma’s deep insurance expertise, Clive automates routine tasks, dynamically plans claim handling, and advances the claim automatically according to the insurer’s operating procedure (SOP).
By leveraging AI, Clive handles repetitive and manual processes like data entry, document classification, reserving, and FNOL intake with speed and precision. However, his true uniqueness lies in his ability to guide adjusters through more complex challenges, such as understanding what the next step in advancing a claim should be, what documents are missing, and other decision-making processes, by providing contextually relevant, data-based insights and recommendations.
Clive empowers claims adjusters to work with confidence and speed, helping them with routine and manual tasks as well as complex decision making.
Adjusters save valuable time and reduce errors, while maintaining control over key decisions. For claims managers, Clive provides real-time visibility into operations, enabling them to spot trends, manage workloads, and ensure compliance effortlessly.
With Clive, Five Sigma demonstrates that simplicity is not the opposite of depth and ingenuity, but its foundation. By turning disjointed workflows into unified systems, Clive is reshaping claims management, showing how intricate processes can be simplified without losing their effectiveness.