Customers are using AI to challenge insurers - it’s time to change the game

In recent months, a striking trend has emerged across social media: consumers are using AI tools such as ChatGPT to successfully overturn rejected insurance claims. Armed with little more than a decline letter, their policy documents, and a few carefully crafted prompts, individuals are managing to reverse decisions that once took months – sometimes in just hours. 

This shift should serve as a catalyst for change, not a cause for concern. At Firemind, we believe insurers now have a powerful opportunity not simply to catch up with consumers’ use of AI, but to lead – by deploying generative AI to deliver customer experiences so seamless and fair that there’s no reason for a claim to be contested in the first place. 

Rather than viewing AI as a defensive measure to counter appeals, insurers can use it to eliminate dissatisfaction from the outset. Smarter claims processing, personalised communication, and faster, clearer decisions can build the kind of trust and transparency that keeps policyholders satisfied and loyal. Firemind enables insurers to move from reactive processes to proactive, rewarding customer journeys – powered by AI, and built for trust. 

What Firemind has already proven: AI in complex, document-heavy industries 

At Firemind, we’ve already demonstrated how generative AI can transform sectors with high volumes of complex documentation. In our work with the Bank of Ireland’s legal team, we reduced routine legal task time by 20% – effectively giving each solicitor an additional working day per week Similarly, for MRH Trowe, a leading insurance broker in Germany, we built a document processing pipeline that reduced manual data extraction time from 2.5 hours to just 7 minutes.  

Our method included building a secure, cloud native architecture powered by large language models like Anthropic’s Claude, delivered with the human expert always in the loop. This approach is ideal for the insurance sector, where customer experience, fairness and compliance matter just as much as efficiency. 

How to use AI to help improve customer satisfaction in the claims handling process 

Here’s how Firemind would bring this expertise to claims transformation:

1. Automated Policy Interpretation

Using Anthropic Claude and custom fine-tuned models, we can automatically compare claim details with policy wording to determine coverage eligibility. This minimises missed conditions, accelerates decisions, and increases consistency across teams. 

2. Intelligent Case Routing

AI triages claims based on factors like complexity, value, and urgency. Straightforward cases are fast-tracked, while complex ones are flagged for specialist review – improving outcomes for all parties. 

3. Instant Document Understanding

Much like our work with the mortgage market, we can automate the classification, extraction, and validation of data from uploaded claim documents – regardless of layout or source. These are converted into structured, machine-readable formats in seconds. 

4. Transparent Decision-Making

Our AI systems generate human-readable explanations of claim decisions – invaluable for internal audit trails, regulatory compliance, and customer clarity. 

5. Continuous Learning from Appeals

Overturned claims provide valuable feedback. Our systems can learn from these to reduce future rejections, improve prompting logic, and even identify systemic issues within policy wording or workflows. 

Human-first, AI-enhanced 

Firemind doesn’t seek to replace claims handlers – we empower them. Just as we gave legal teams time back for higher-value work, our claims solutions free up handlers to focus on complex assessments, customer support, and empathetic communication. 

Helping insurance companies achieve greater levels of customer service 

Insurance companies today are facing AI-literate consumers who know how to navigate their policies and demand what they’re entitled to – often with help from tools like ChatGPT. To remain competitive and trustworthy, insurers must meet this challenge head-on by adopting AI themselves. 

Firemind brings deep expertise in building AI-powered, AWS-native solutions tailored to regulated, document-heavy industries. With our help, insurers can not only streamline operations but also improve outcomes for customers and their own bottom line. 

Keen to future-proof your claims operation? 

Contact Firemind to explore how our GenAI advisory services and solutions can give your team – and your customers – the confidence and swift outcome they deserve