​​Claims Management of the Future: Matching Automation and Empathy ​

EXECUTIVE SUMMARY 

Claims management is a critical moment for insurance companies, as it often determines whether the costs of their services are justified. With increasing claim volumes and rising customer expectations, insurers are under significant pressure to modernize their processes while still maintaining the essential human traits that are crucial for customers experiencing stress. This project, conducted for Generali Versicherung AG, explores how an attribute-based hybrid framework can effectively address the two essential needs of efficiency and empathy in the insurance market. 

Goal 

The goal of this project was to design a practical framework for future claims management that systematically balances automation and human empathy. The project has identified which attributes will shape customer expectations over the next five to ten years. The analysis also examined where AI creates genuine value in claims processing, where human involvement is non-negotiable, and what implications arise for operational design in an increasingly digital insurance environment. 

Methodology 

The project followed a two-stage research approach combining a structured PEST analysis with qualitative expert interviews. The PEST analysis addressed the external forces reshaping claims management. Building on its foundation, semi-structured expert interviews were conducted with senior practitioners across insurance management, academic research, and strategy consulting. The resulting insights were structured and validated through an attribute-based hybrid Human-AI framework, applied to two detailed healthcare scenarios representing fundamentally different levels of claim and emotional complexity. 

Results 

The results indicate that future claims management cannot follow a one-size-fits-all approach. Speed is a baseline expectation, essential for trust, but no longer a differentiator. Transparency fills the gap: customers need to know what was decided, why, and what comes next. Silence between contact points is interpreted as abandonment.  

Generational analysis reveals a counterintuitive finding: Gen Z customers prefer digital self-service for routine interactions but expect human judgment when stakes are high. This challenges the assumption that younger customers simply want more technology. 

Building on these insights, a four-mode hybrid framework was developed around claim and emotional complexity. It serves as an operational routing logic that distinguishes between situations suited to AI-led resolution and those requiring dedicated human ownership, ensuring the right response reaches the right customer at the right moment. 

The recommendations highlight the importance of deliberate mode assignment per claim type and a cohesive AI-human collaboration model that concentrates human expertise at the moments that matter most. 

Cooperation Partner 

• ​​Generali Versicherung AG 
  Landskrongasse 1-3,  
  1010 Vienna 
  Austria 
  www.generali.at​ 

​​Contact Person​ 

• ​​Lukas Rendl  
  LUKAS.RENDL@generali.com​ 

Student Team 

• ​​​Anastasiia Lipianina  
  Oktay Mammadov  
  Oleksandr Natochyi  
  Nina Rose  
  Kenzo Schmitz  
  Ibrahim Esad Yorulmaz​​ 

Project Manager 

• ​​Melina Mazzucato, M.Sc. (WU), M.Sc. (NOVA) 

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