The Property and Casualty (P&C) insurance industry stands at a critical juncture due to volatile market forces and rising customer expectations. Heightened competition, increasing catastrophic event frequency, and an urgency to drive digital-first interactions fuel transformation initiatives in claims. Traditional methods that rely heavily on human intervention are prone to inaccuracies, prolonged cycle times, and resource inefficiencies, compelling insurers to explore avenues for faster, more transparent claims experiences. In response, AI-enabled claims management solutions have emerged as a strategic priority. They blend predictive analytics, workflow automation, real-time fraud detection, and advanced integration capabilities, enhancing operational effectiveness and customer satisfaction. Against this backdrop, this assessment highlights how targeted solutions and partnerships are reshaping the claims landscape. These solutions enable carriers to streamline the entire life cycle, from first notice of loss to post-settlement support, and pave the way for resilient, data-driven operating models. In this report, we analyze 17 technology providers as part of the AI-enabled Claims Management Systems for Property and Casualty (P&C) Insurance – Products PEAK Matrix® Assessment 2025. Scope Industry: Insurance Geography: global Contents In this report, we: Assess 17 technology providers Position providers as Leaders, Major Contenders, and Aspirants Compare providers’ key strengths and limitations

In the dynamic healthcare landscape, efficient claims management is vital. Traditionally, the claims management process relies on manual efforts and human judgment. Today, advanced analytics allow healthcare payers to optimize costs, reduce fraudulent claims, ensure regulatory compliance, and lower claims denial rates. Implementing analytics strategically in the healthcare ecosystem has significantly enhanced the claims management life cycle. In this report, we examine the role of analytics in transforming claims management, emphasizing the importance for healthcare payers and providers to prioritize analytics in claims management processes. The report assesses key trends, technologies, and focus areas in claims analytics, offering a comprehensive overview of how these advances lead to more efficient and effective systems. Additionally, it addresses the challenges providers face in adopting and implementing analytical techniques while offering insights into overcoming them. The report also examines the current state of claims management, offering actionable recommendations to use analytics to streamline operations and improve outcomes. It will help stakeholders understand the transformative potential of analytics in healthcare claims management and develop strategies to harness its benefits. Scope Industry: healthcare Geography: global Contents In this report, we: Examine the role of analytics in transforming claims management, highlighting how it can optimize costs, reduce fraudulent claims, ensure regulatory compliance, and lower claims denial rates Identify challenges healthcare payers face in adopting analytics and offer insights to overcome them Assess the current claims management status in the healthcare landscape Recommend best practices for using analytics to enhance efficiency and effectiveness Membership(s) Healthcare Payer and Provider Information Technology Sourcing and Vendor Management

To expedite recovery from an unstable business environment and future-proof the business, insurers have heavily invested in modernizing their IT estate. They have focused on enhancing operational capabilities for efficiency and productivity gains, adopting data-driven decision-making. Generative AI (GAI) promises insurers additional value extraction and accelerated modernization efforts. Although GAI can revolutionize core insurance functions, a well-thought-out, holistic adoption roadmap should start small, prove incremental business value, and scale up quickly. The starting point varies for different Property and Casualty (P&C) insurers based on industry headwinds’ impact and their technology estate’s maturity. Thus, insurers must prioritize mandates requiring urgent attention and those offering quick wins. In the current market environment, claims serve as a logical starting point for most P&C carriers, particularly in personal lines. Implementing GAI capabilities in this area allows for testing with minimal investment and disruption to live claims, making it an ideal starting place. Moreover, it offers major cost centers, such as claims organizations, an opportunity for efficiency gains in the near term, improved claims accuracy, and envisioning a complete reimagination of the claims value chain over the long term. In this viewpoint, we explore the need and potential impact of GAI across insurance core operations. Scope Industry: insurance Geography: global Contents In this viewpoint, we: Explore evolving market sentiment and priorities for P&C insurers Discuss the increasing interest and investment in GAI as the next frontier Identify claims operations as a logical starting point for P&C insurers’ GAI adoption journey Provide a potential roadmap and key considerations for GAI adoption within claims Membership (s) Artificial Intelligence (AI) Insurance Information Technology Sourcing and Vendor Management

Customer expectation for an Amazon-like experience is driving Property and Casualty (P&C) insurers to reevaluate their digital transformation strategies. However, workflow complexities due to multiple intermediaries and legacy systems are resulting in high turnaround time, information leakages, frauds, and, ultimately, a subpar customer experience. To establish a digital-first operating model, insurers initially digitized their sales and distribution operations but soon shifted their focus to low-touch and seamless core operations such as claims management to generate superior efficiency, leverage data and ecosystem insights to identify fraud, and improve the claims ratio by building predictive and preventive capabilities. This compendium provides detailed and fact-based snapshots of 17 digital claims solution providers featured on the Digital Claims in P&C Insurance Solutions PEAK Matrix®. Each profile provides a comprehensive picture of the provider’s strengths and limitations. The compendium will enable providers to benchmark their capabilities against their peers, while buyers will be able to assess the providers based on their sourcing needs. Scope: Industry: insurance Geography: global The assessment is based on Everest Group’s annual RFI process for calendar year(s) 2021-22, interactions with leading digital claims solution providers, client reference checks, and an ongoing analysis of the insurance digital claims market Contents In this report, we: Provide the Digital Claims in Property and Casualty (P&C) Insurance Solutions PEAK Matrix® Assessment 2023 Examine 17 digital claims solution providers’ offerings, along with their vision, product capabilities, adoption across geographies, case studies, partnerships, and investments Discuss client success stories, including the business challenges addressed, services delivered, and impact generated Study the providers’ domain investments, key Intellectual Property (IP) / solutions, and key partnerships Present Everest Group’s perspective on the key strengths and limitations of the 17 digital claims solution providers Membership(s) Insurance Information Technology Sourcing and Vendor Management

Customer expectation for an Amazon-like experience is driving Property and Casualty (P&C) insurers to reevaluate their digital transformation strategies. However, workflow complexities due to multiple intermediaries and legacy systems are resulting in high turnaround time, information leakages, frauds, and, ultimately, a subpar customer experience. To establish a digital-first operating model, insurers initially digitized their sales and distribution operations but soon shifted their focus to low-touch and seamless core operations such as claims management to generate superior efficiency, leverage data and ecosystem insights to identify fraud, and improve the claims ratio by building predictive and preventive capabilities. In this report, we assess 17 digital claims solution providers featured on the Digital Claims in P&C Insurance Solutions PEAK Matrix®. The study will enable buyers to choose the best-fit provider based on their sourcing considerations, while providers will be able to benchmark their performance against each other. Scope: Industry: insurance Geography: global The assessment is based on Everest Group’s annual RFI process for the calendar year 2021, incremental updates sought from the solution providers in 2022, interactions with leading digital claims solution providers, client reference checks, and an ongoing analysis of the digital claims solution market Contents In this report, we: Examine P&C insurers’ vision to build a zero-touch claims journey and the critical technology components powering this vision Assess 17 leading digital claims solution providers for the P&C insurance industry on Everest Group’s Solutions PEAK Matrix® evaluation framework List the characteristics of Leaders, Major Contenders, and Aspirants Present Everest Group’s take on the strengths and limitations of each provider Membership(s) Insurance Information Technology Sourcing and Vendor Management

The Property and Casualty (P&C) insurance industry deals with a large amount of claims data for multiple lines of business, ranging from houses to vehicles. Standard mechanisms to process claims require multiple data entry points from numerous sources and coordination among various parties simultaneously. This kind of sensitive exchange of data is a challenging task for insurers today, involving high risk transactions between multiple stakeholders and linking and tracking this web of data and its exchange to outcomes such as loss expenses incurred, fraud detection, and impact on underwriting. Switching to blockchain-enabled smart contracts will help automate this process and put in place a digital audit trail, thereby reducing risks significantly. Transactions made on blockchain are immutable in nature, and hence highly secure and almost impossible to tamper with, making blockchain extremely suitable for processing claims in the P&C industry. To understand the potential of blockchain in the industry and present a way forward for its adoption, this viewpoint explores the technology with a keen focus on: Blockchain’s adoptability and potential in P&C claims processing Assessment of blockchain in P&C claims processing using Everest Group’s prioritization framework Challenges to blockchain adoption in P&C claims processing Role of third parties in adoption Membership(s) Insurance - Business Process Outsourcing (BPO)

Health insurance claim denials cost payers and providers over US$300 billion every year. Other than the financial loss, both the payers and the providers incur additional administrative burden, increase A/R cycle, and loss of member goodwill. Take the example of providers who spend almost US$9 billion every year in appeal costs. The key factors contributing to incorrect claims are similar across both the entities. Whether it is lack of uniform data collection standards, use of fragmented systems, lack of process optimization, or use of legacy platforms, both the payers and providers are struggling with analogous issues. The problem of claim denials is not unsolvable; however, payers and providers need to make strategic investments to address the issue. To know more about these investments, download the paper… The viewpoint covers the entire denial management problem in detail, with specific focus on: Key drivers of incorrect claims How instances of incorrect claims can be reduced The benefits of adopting a digitally transformative approach for the stakeholders Case study explaining how an enterprise utilized a claim denial solution to improve accuracy while reducing claim processing time Membership(s) Healthcare & Life Sciences BPO