Less time remembering and searching. More support for the work that requires judgment.
An examiner’s expertise shows in how they interpret information, recognize when something needs closer review and decide who else should be involved. That gives AI a practical assignment: help bring missing information, relevant requirements and next steps front-and-center. The examiner’s responsibility remains to interpret that information and determine how the claim should be handled.
With the introduction of Kiva, Benekiva’s AI Smart Claims Assistant, that distinction shapes the conversation. Embedded in the claims workflow, Kiva surfaces relevant reminders, flags incomplete information and helps examiners identify what needs attention next. Its purpose is to support the person handling the claim, not act as an independent claims decision-maker.
Krista Eger, Benekiva’s Vice President of Product and a former claims examiner, questions how much examiners should have to keep in their heads.
“I don’t think an examiner’s value is in how much they can remember without help,” Eger said. “It’s in how they interpret information, recognize when something needs a closer look, and know when to bring someone else into the conversation.”
Supporting that expertise requires more than making information available somewhere in the system. The timing and placement of guidance matter, too.
“An examiner shouldn’t have to realize they may have missed something before they can get support,” Krista said. “A reminder is more useful when it shows up while someone is working through the requirement it relates to.”
That is an important distinction between answering a question and helping someone recognize that a question needs attention. The latter is why bringing relevant guidance into the workflow matters. Guidance should help the examiner find the work that requires attention. It should not be mistaken for a conclusion about how the claim should be handled.
For Jim Girard, Benekiva’s Vice President of Engineering, a straightforward demonstration is only the beginning of evaluating a tool.
“It’s relatively easy to show a clean path through a claim,” Jim said. “The information is complete, everything arrives where it should, and the next step is obvious. But what happens when it isn’t?”
His questions become more specific when information is missing or progress stops. Can the examiner understand what is holding up the claim? Does the system help them investigate, or do they need to leave it and piece the situation together elsewhere?
“You’re not going to automate every exception. That isn’t realistic,” Jim said. “But a difficult claim should get more support from the technology, not less. Those are exactly the situations where people need better tools.”
That gives carriers a useful question to bring to an AI demonstration: What can the examiner see and do when the claim does not follow the straightforward path? The answer should clarify both the assistance available and its limits.
Finding the next step is one responsibility. Deciding whether it is appropriate is another.
“Keeping a human in the loop needs to mean more than asking someone to approve what a system has already decided,” Krista said. “There needs to be room for that person to question something, look closer, and recognize when the circumstances need additional review.”
That is a practical standard for evaluating AI assistance. Can the examiner question the guidance? Can they investigate further? Is it clear which decisions remain theirs? Kiva’s role is to assist, not independently decide a claim. Preserving that distinction means treating the examiner’s judgment as part of the work to support, not a final approval step to get through.
For Brent Williams, Benekiva’s Founder and CEO, the value of these improvements comes back to the connection between the examiner’s work and the person waiting for benefits.
“A missing document can sound like a small operational issue until you remember that someone is waiting for the claim to move forward,” Brent said. “Helping an examiner notice something earlier isn’t just about making a screen more useful. It’s about supporting the work that has to happen for someone to receive their benefits.”
Interested in learning more? See Kiva in action.
