Sedgwick launches AI-powered care guidance application for claims management

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Sedgwick Claims Management Services, Inc.

May 06, 2024, 12:00 ET

MEMPHIS, Tenn., May 6, 2024 /PRNewswire/ -- Sedgwick, a leading global provider of claims management, loss adjusting and technology-enabled business solutions, today announced the expansion of its artificial intelligence (AI) offerings with a new application that integrates with claims systems to identify workers' compensation claims whose progression could benefit from early clinical intervention.

The AI-powered care guidance is designed to supplement the efforts of Sedgwick's talented claims professionals in ensuring timely, quality care for injured and ill workers. The proprietary model uses modern AI, machine learning and natural language processing to rapidly review unstructured data — such as claim notes, correspondence, medical bills, and clinical documentation — and collect meaningful, actionable information for review.

By identifying subtle patterns that might otherwise be overlooked, AI care guidance detects the warning signs of claim severity early in the process and facilitates prompt referrals to appropriate clinical resources, including case management, surgery support, pharmacy management and behavioral health specialists. The purpose is to support injured and ill employees on the road to recovery and healthy and productive living.

"The AI care guidance application is our new paradigm for combining innovative technologies with human connection in the claims process," said Adam Fisher, Sedgwick's Chief Data Officer. "It builds on our decision optimization tools and other uses of generative AI and analytics to unleash the power of data for the benefit of those whose care is entrusted to us."

The AI care guidance model, along with Sedgwick's AI-powered smart.ly, mySedgwick and viaOne platforms and the Sidekick application introduced last year, are designed to transform the way people interact with and leverage technology for better claim outcomes.

"Early results from our AI care guidance pilot indicate that the timely clinical interventions enabled by the model are making a meaningful difference in the health and well-being of our clients' injured and ill employees," said Josephine Copeland, Sedgwick's Senior Vice President of Managed Care Product Design and Strategy. "This innovative tool will help our examiners enlist the right clinical specialists to support people through the workers' compensation claim journey."

Sedgwick plans to implement AI care guidance in a phased approach, based on the needs and preferences of each of its U.S. managed care clients and in line with the ethical guidelines and codes of conduct set forth by the National Association of Insurance Commissioners (NAIC) and the European Union (EU). The company aims to apply lessons from the model to other lines of business, including liability claims involving bodily injury.

With 2,000 dedicated IT and data science colleagues, Sedgwick continues to deliver exceptional technology-enabled solutions that support many of the world's premier employers and insurers. For more on Sedgwick's technology offerings, see sedgwick.com/solutions/technology.

About Sedgwick
Sedgwick is a leading global provider of claims management, loss adjusting and technology-enabled business solutions. The company provides a broad range of resources tailored to clients' specific needs in casualty, property, marine, benefits, brand protection and other lines. At Sedgwick, caring counts; through the dedication and expertise of 33,000 colleagues across 80 countries, the company takes care of people and organizations by mitigating and reducing risks and losses, promoting health and productivity, protecting brand reputations, and containing costs that can impact performance. Sedgwick's majority shareholder is The Carlyle Group; Stone Point Capital LLC, Caisse de dépôt et placement du Québec (CDPQ), Onex and other management investors are minority shareholders. For more, see sedgwick.com.

SOURCE Sedgwick Claims Management Services, Inc.