Insights
A Claim File Never Tells the Whole Story
Armando Andrade
A claim file records what happened, but experienced judgment explains why decisions were made. Armando Andrade, Head of Claims Strategy, on how technology can strengthen the decis…
Updates from Elysian
Insights
What Does it Mean to have a Human in the Loop for Automated Decisions
Grace Hanson
None of the bills reviewed in this series defines what "sole basis" means in operational terms. This part covers what a defensible record of human review should show, three habits…
Insights
The potential pitfalls in automated decisions and actions
Grace Hanson
We found no court that has held the use of AI in a claim decision unlawful in itself. Health insurance suits over algorithmic denials and P&C cases over total-loss valuation softw…
Insights
The impact of P&C rules and adjuster licensing on AI Denials
Grace Hanson
No state has enacted a law that explicitly bars P&C insurers from denying a claim on the basis of AI alone. Florida and New Jersey have proposed limits, regulators have set govern…
Insights
The state of AI Agent Claim Denials
Grace Hanson
Thirteen states limit how health insurers may use AI to deny claims. None applies to auto, homeowners, or commercial lines, but the practical standard in P&C is likely to converge…
Insights
Delivering Claims Results — Part 4: Unify Oversight, Eliminate Gaps
Grace Hanson
The fourth installment of Delivering Claims Results looks at what it takes to unify claims oversight and close the visibility gaps that let issues go unnoticed until they are expe…
Insights
Delivering Claims Results — Part 3: Why Simple Tech Falls Short
Grace Hanson
The third installment of Delivering Claims Results looks at why simple, bolt-on technology falls short of the outcomes carriers and TPAs actually need from claims oversight.
Insights
Delivering Claims Results — Part 2: Intervening Before It's Too Late
Grace Hanson
The second installment of Delivering Claims Results looks at why catching problems early in a claim, before they compound, is what actually drives better outcomes.
Insights
Delivering Claims Results — Part 1: Exposing Hidden Claim Errors
Grace Hanson
The first installment of Delivering Claims Results, a new Elysian Era series, traces specific claims outcomes back to the design choices that made them possible.
Insights
Why Being an AI-Native TPA Matters — Part 4: Empowering Adjusters, Reducing Attrition
Grace Hanson
The fourth and final issue of The Elysian Era's inaugural series looks at why adjuster retention depends on better tools, not just tracking adjuster output.
Insights
Why Being an AI-Native TPA Matters — Part 3: Building Brand Through Customer Experience
Grace Hanson
The third issue of The Elysian Era examines how claims handling, not marketing alone, builds a carrier's or TPA's brand with the policyholders it serves.
Insights
Why Being an AI-Native TPA Matters — Part 2: Underwriting Intelligence From Every Claim
Grace Hanson
The second issue of The Elysian Era looks at how structured, accessible claims data can sharpen underwriting decisions instead of sitting unused after a file closes.