Claims Leaders Adopted Predictive Modeling and AI

Rising Medical Solutions released a study showing how AI integration is impacting U.S. workers' compensation.

Updated on Sept. 24, 2026 in Remote Work

Isometric editorial illustration featuring a neat, architectural stack of white files on a dark surface, representing data-driven claims management. — Rising Medical Solutions' new industry report shows that 41% of insurance claims leaders have integrated predictive modeling and AI tools into their operations. AI Illustration. Upload story photo >

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A new industry report from Rising Medical Solutions reveals that 41% of claims leaders now utilize predictive modeling and AI-driven analytics. The study highlights significant operational improvements for users, alongside persistent challenges regarding administrative and compliance workloads.

Why it matters

The study suggests that AI tools are becoming a differentiator in performance, with higher-performing organizations adopting these technologies at a significantly higher rate than their peers. Addressing heavy administrative burdens remains a primary focus for the industry as it attempts to shift resources toward core claims activities.

The benchmarking study surveyed 338 claims leaders, finding that 57% of higher-performing organizations use AI compared to 34% of lower-performing ones. Currently, 35% of users have not assessed the effect of these tools on claim closure outcomes.

The players

Rising Medical Solutions

This organization is a provider of medical cost containment and workers' compensation services that conducts industry-wide benchmarking research.

The details

Fifty percent of users reported improved claim closure outcomes, and 58% noted higher frontline staff efficiency since implementing these analytical tools. However, 85% of total respondents cited heavy administrative and compliance tasks as the primary hindrance to performing other vital claims activities.

Survey responses were collected between November 2025 and January 2026.
The benchmarking study was officially released on September 24, 2026.

Market Landscape

This move toward AI integration follows the pattern set by the 2025 Workers' Compensation Benchmarking Study in quantifying how technology adoption differentiates high-performing organizations. It reflects a broader industry shift toward automating manual compliance tasks to improve overall claims efficiency.

The adoption of these technologies by claims leaders may lead to faster processing times and more efficient communication for workers filing claims. However, until organizations address the 85% of administrative workload that hinders activity, claimants may still face delays due to compliance requirements.

The takeaway

Organizations that fail to measure the specific impact of their AI tools may miss opportunities to optimize staff efficiency and claim closures. Leaders should prioritize assessing these metrics to determine if their technology investments are actually yielding the desired operational results.