AI in Action: Enhancing Client Outcomes and Team Efficiency

At CorVel, our national network of adjusters, analysts, and case managers drive consistent client success through their expertise and dedication. Across offices, it’s our people who enable the organization to deliver industry-leading outcomes year-round.

So, how do they do it? At the core of high-performing teams are adaptable tools that bridge the gap between human capacity and evolving workloads. At CorVel, artificial intelligence (AI) is a catalyst for continuous improvement, enhancing productivity, supporting smarter decision-making, and empowering staff to perform at their highest level. The result? Exceptional client service and stronger program results.

Here are three ways CorVel is applying AI to deliver measurable results for clients.

Use Case #1: Verification and Accuracy

It is estimated that 80% of medical bills contain errors. Left uncorrected, these errors can lead to increased costs or delayed patient care.

At CorVel, both Optical Character Recognition and Intelligent Character Recognition (ICR) are used to extract details from standard and non-standard bills. The captured data is presented in the Intelligent Viewer, an internal review interface that makes it easy for analysts to validate information. If required fields cannot be read, the system routes bills to a human reviewer for verification.

Once validated, the information is seamlessly integrated into CorVel’s bill review systems, allowing analysts to quickly locate details such as provider names or pharmacy entries. This process has reduced errors, accelerated turnaround times, and helped workers receive the right care without delay.

Use Case #2: Automation

While not AI in the strict sense, rules-based automation is an important complement to AI within claims management. It helps reduce repetitive, manual work by applying predefined rules to speed up bill processing.

For example, CorVel’s auto-approval application uses specific criteria to allow certain previously approved bills to bypass further review. In 2025, this automation is projected to reduce manual approvals by more than 20%, saving adjusters 1.5 to 2 hours each week, the equivalent of a full workday every month.

In California, automation is also optimizing the bill denial process. With this added efficiency, providers receive faster decisions, allowing them to pursue alternative treatment options more quickly. For adjusters in this jurisdiction, auto-denial capabilities have led to a 14% reduction in bill review workload.

By reducing administrative burden, our automation tools enable adjusters to focus more time on high-impact tasks, such as proactive outreach and personalized care coordination. This allows them to connect directly with injured workers, gain insights into their unique needs, and align their efforts with program objectives to deliver more tailored, outcome-driven service.

Use Case #3: Predictive Modeling

AI’s most exciting promise in workers’ compensation lies in predictive modeling. At CorVel, predictive modeling is used to determine risk scores, effectively pinpointing which claims are more likely to require additional intervention. This capability, part of our Care^MC Edge platform, analyzes factors such as claim history, pain levels, and claimant compliance. Scores are updated in real-time as new information is added, ensuring clients remain informed as cases evolve.

Predictive modeling also plays a critical role in litigation risk assessment. Once a claim is flagged in the system, adjusters may initiate additional interventions, such as coordinating with nurse case managers or contacting the injured worker directly. With the average claim cost exceeding $41,000, reducing litigation risk is essential. In 2022 alone, CorVel’s litigation risk scoring helped achieve a $2 million reduction in client legal spend.

The ability to anticipate claim complexity before it escalates empowers our teams to take proactive steps that reduce costs, shorten recovery times, and protect the well-being of injured workers.

A Comprehensive Approach to AI Integration

While these examples show AI’s impact in specific areas, our broader approach ensures each implementation is strategic, ethical, and aligned with measurable goals.

CorVel considers the following factors when integrating AI into its services:

• Accuracy: Models are trained on complete, up-to-date datasets to minimize factual errors.
• Privacy: All data is safeguarded and used only for performing the services we provide to customers, in line with contractual and regulatory requirements.
• Bias: AI tools are used for procedural and analytical tasks that support — not replace — human decision-making, minimizing bias risk. These tools do not directly make claim decisions that impact injured workers.
• AI Hallucination: Human-in-the-loop review ensures all AI outputs are validated before any action is taken.
• Transparency: Results and insights are documented and shared with relevant stakeholders to support informed, human-led decision-making.

These pillars reflect CorVel’s commitment to responsible and ethical innovation, ensuring trust, compliance, and transparency as AI capabilities evolve.

What’s Next for AI?

A technology-driven culture requires ongoing innovation. At CorVel, we regularly update our models with fresh data and insights to optimize performance and stay ahead of evolving program needs.

We are actively researching agentic AI applications to power the next wave of innovation in claims management. Early initiatives under evaluation include automating routine workflows, enhancing decision support for complex claims, and improving efficiency through dynamic case triage. These efforts are forming the foundation for increasingly adaptive systems driven by predictive modeling, natural language processing, and agentic AI.

Looking ahead, we will continue to expand our R&D efforts to strengthen operational performance and deliver long-term value. The goal is clear: ensure technology remains agile, impactful, and aligned with the needs of both clients and injured workers.

Connect with Us

At CorVel, we’re not just implementing AI, we’re integrating it purposefully to support our teams, optimize outcomes, and deliver meaningful value to our clients.

Interested in learning how our AI-driven solutions can support your claims program? Contact us today to schedule a consultation or product demo.