Claims Management - Policy Administration & Billing - Agent & Policyholder Portals - AI, Analytics & Bots

SpearClaims™ Accessible AI Use Cases

Accessible AI in SpearClaims™ empowers business users to shape AI models to their specific needs - helping teams work smarter, respond faster, and make more confident decisions with less effort.

Artificial Intelligence for Insurance

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SpearClaims™

These are just a few of the use cases made possible by business user accessible AI. 

Spear's Next-Generation AI Capabilities leverage generative AI, predictive analytics, and intelligent automation to solve real-world challenges for insurers, TPAs, and public entities.

Accessible AI makes working with AI intuitive—no developers required. Business users can tailor models to their unique needs and domain realities, ensuring the technology works for them—not the other way around.

The result: faster decisions, smarter workflows, and a stronger return on your technology investment.

To learn more about the use cases and their impact, click on a Next-Generation AI Capability.

  • Proactively Managing High-Risk Claims with Predictive Analytics
  • Accelerating Claims Review with Smart Summarization
  • Streamlining Email Workflows with the Claims Assistant Email Agent
  • Enhancing Customer Experience with Sentiment-Aware Automation
  • Reducing Manual Work with Intelligent Document Processing
  • Empowering Vendors with Self-Service Virtual Agents
  • Speeding Up Form Entry with Smart Paste
  • Navigating Complex Systems with Copilot Assistant
  • **Currently Live SpearClaims™ Use Case**

Proactively Managing High-Risk Claims with Predictive Analytics

Reduce litigation costs and speed up intervention in high-risk claims.

Spear’s embedded predictive models automatically flag claims likely to esalate (e.g., litigation, fraud, delayed recovery) and trigger alerts or pre-set workflows—such as routing to senior adjusters or initiating early intervention protocols.

 

Outcome:

  • Up to 30% reduction in litigated claims
  • Faster triage and resolution of complex claims
  • Improved loss ratios and lower legal expenses

Accelerating Claims Review with Smart Summarization

Significantly reduce time required to review notes, emails, and task logs.

Smart Summarization condenses case activity into clean, actionable summaries—auto-generating highlights of emails, calls, tasks, and notes.

 

Outcome:

  • Review time reduced by up to 60–70%
  • Less time spent scrolling; more time spent acting
  • One-click copy streamlines status reporting and case reviews

Streamlining Email Workflows with the Claims Assistant Email Agent

Improve response rate on time-sensitive communications.

The Email Agent reads incoming emails, extracts relevant claim information, and drafts real-time, in-thread responses using generative AI—with options.

 

Outcome:

  • Email response time cut in half
  • Higher accuracy in claim file updates
  • Consistent, professional communication across the team

Enhancing Customer Experience with Sentiment-Aware Automation

Enable staff to proactively address negative claimant or stakeholder interactions.

Sentiment analysis flags emotionally charged or urgent messages and alerts supervisors in real time, suggesting tailored responses.

 

Outcome:

  • Faster intervention on escalated issues
  • Significantly improved claimant satisfaction scores
  • Fewer complaints slipping through the cracksmproved loss ratios and lower legal expenses

Reducing Manual Work with Intelligent Document Processing

Seamlessly and automatically extract data from medical reports, invoices, and policy documents.

AI models extract key data and populate records in SpearSuite™ automatically, reducing rekeying and ensuring accuracy.

 

Outcome:

  • Up to 80% reduction in manual data entry
  • Higher data integrity
  • Faster claim setup and reimbursement cycles

Empowering Vendors with Self-Service Virtual Agents

TPAs and vendors frequently contact stakeholders for status updates or document requests.

Virtual Agents securely access real-time data and respond to routine inquiries, perform tasks, and trigger processes like document uploads or payment checks—without human intervention.

 

Outcome:

  • Significant reduction in inbound support requests
  • 24/7 vendor self-service capabilities
  • Staff freed up to focus on higher-value work

Speeding Up Form Entry with Smart Paste

Intelligent copy & paste eliminates repetitive manual form entries, data copying and errors.

Smart Paste recognizes copied text and suggests relevant form field inputs, enabling one-click data population. 

Outcome:

  • Up to 50% faster data entry
  • Significantly fewer errors and rework
  • More time available for analytical or decision-making tasks

Navigating Complex Systems with Copilot Assistant

Assists new staff rand other users with system navigation and locating relevant reports or data.

Provides natural language help within SpearSuite™, offering guided navigation, dynamic insights, and recommendations based on the user’s task or query.

Outcome:

  • Reduced training time for new users
  • Increased adoption of advanced system features
  • More confident, independent users

**Currently Live SpearClaims™ Use Case**

A business user successfully deployed 12 AI models in SpearSuite™ to automate tasks previously being done manually and is now successfully reading invoices and indexing them to claim files, entering payments based on invoices, processing documents, and summarizing notes, leading to measurable efficiency gains.

Outcome:

  • Significantly reduced manual workload
  • High accuracy performing automated tasks
  • Increased efficiency