Building a Modern Claims Organization: Gina Reyes’ Playbook for an Increasingly Complex Claims Landscape
Building a modern claims organization has never been more challenging.
Claims are becoming more technically complex. Customers expect faster, more transparent communication. Third parties are becoming more sophisticated. AI is rapidly changing how work gets done, while raising new questions about where technology should help and where human judgment still matters most.
Few claims leaders have had the opportunity to rethink and design how claims should operate from first principles.
When Gina Reyes joined Openly, she wasn’t inheriting decades of established processes. She was helping build a claims organization from the ground up alongside a technology-first carrier. That meant every hiring decision, workflow, operating model, and technology investment could be designed around the realities of today’s insurance market rather than yesterday’s.
As Openly has grown, that foundation has been continually refined. Not because the original vision was wrong, but because the industry itself continues to change.
That ability to adapt has become one of the defining characteristics of Openly’s claims organization. Drawing on her experience building the organization from the ground up, Gina offers a practical playbook for what modern claims leaders should prioritize as complexity continues to rise.
The Industry Context
Technology has changed nearly every part of the claims process.
FNOL can be handled agentically. Correspondence can be generated automatically. Quality assurance can review more files than ever before. Many of the repetitive administrative tasks surrounding a claim are becoming increasingly automated.
The industry expectation is that these productivity gains will enable a single adjuster to handle significantly more claims.
At the same time, the claim itself has become more demanding. Customers are filing fewer routine claims while the claims that do enter the system often require greater technical expertise.
Catastrophe losses continue to rise, reconstruction costs remain elevated, and claims increasingly require more documentation, policy interpretation, coordination across vendors and third parties, and communication with policyholders than they did only a few years ago. At the same time, adjusters are navigating increasingly sophisticated contractors, public adjusters, attorneys, and regulatory expectations, all while policyholders expect faster and more transparent communication.
Claims professionals are expected to navigate complex coverage conversations while delivering an experience that remains empathetic, responsive, and compliant.
Many claim leaders are asking how technology can help teams do more with less, but in an increasingly complex environment, the bigger question becomes: how can organizations help adjusters succeed when the work requiring human judgment is becoming more important?
For Gina, that unique perspective shaped how Openly built its claims organization from the very beginning.
What Modern Claims Organizations Need
While technology continues to evolve, Gina returned to four principles that have guided how Openly has built its claims organization.
- Hire for industry expertise and empathy that technology can amplify
- Design around the customer experience, rather than internal processes
- Use technology to navigate increasing complexity, not just boost productivity
- Build processes that evolve with the industry
Together, these 4 principles represent a different approach to modernization. Rather than asking technology to define the operating model, Openly has focused on building the right organization first, then using technology to reinforce those decisions.
1. Technical Expertise Matters More Than Ever
Every claims organization values technical expertise.
Gina believes today’s environment has fundamentally changed why that expertise matters.
“The claims environment has become significantly more complex,” she explains. “Adjusters are navigating more sophisticated conversations, more regulatory expectations, and more experienced third parties than they were just a few years ago. Technical expertise has never been more important.”
That reality influenced how Openly built its team.
As a growing carrier, the company intentionally hires experienced adjusters who can confidently interpret policy language, make sound coverage decisions, and navigate increasingly technical conversations from day one. There isn’t the luxury of years-long development programs before adjusters encounter difficult claims. The work demands confidence immediately.
But technical expertise alone isn’t enough.
Customers are often experiencing one of the most stressful moments of their lives. They need someone who can explain complicated decisions with empathy, educate them throughout the process, and build trust even when delivering difficult news.
“Technical expertise gets you to the right decision. Empathy and communication are what help customers understand it. Modern adjusters have to do both exceptionally well.”
For Gina, those capabilities reinforce one another. As claims become more complex, the need for both technical judgment and genuine customer care only becomes stronger.
2. Design Around the Customer, Not Internal Workflows
As claims organizations grow, specialization often follows. One team manages mitigation, another handles contents, and another oversees repairs. Each group becomes more efficient at its portion of the claim.
The customer experience, however, can become increasingly fragmented.
Openly intentionally designed a different operating model.
Rather than moving policyholders between multiple departments, each adjuster owns the claim from beginning to end. Specialists still support inspections, estimates, and other aspects of the claim behind the scenes, but the customer always knows who is responsible.
“Our customers shouldn’t have to figure out our operating model,” Gina says. “They should know who they’re working with, trust that person, and have someone who can guide them through the entire claim.”
That approach asks more of every adjuster, further echoing the need for industry expertise.
It also reflects Gina’s broader philosophy. As claims become more complex, consistency becomes more valuable.
3. Let Technology Absorb Complexity
Much of the industry’s AI conversation centers on productivity.
- How many more claims can an adjuster handle?
- How much manual work can technology eliminate?
Gina believes those questions miss the bigger opportunity.
“The efficiency gains are absolutely real,” she says. “But claims are getting more difficult at the same time. Our goal isn’t to keep giving adjusters more work. It’s to use those efficiencies so they have the time to navigate increasingly complex claims without compromising the customer experience.”
That philosophy shapes how Openly approaches AI.
The organization uses technology to support correspondence, documentation, quality assurance, estimating reviews, self-inspection, and other administrative work surrounding the claim. Those capabilities create meaningful efficiency gains, but they do not replace the adjuster’s role.
Instead, they create more capacity for the work technology cannot do. Rather than replacing expertise, technology helps preserve it.
4. Build for the Future
Building a claims organization from the ground up gave Openly another advantage.
The team wasn’t simply solving today’s operational problems. It was building for the organization it expected to become.
“We’re focused on building processes that won’t just solve today’s problems. Every decision has to support where we’re going over the next several years. If it doesn’t scale with us, we’ll eventually have to rebuild it anyway.”
That philosophy extends beyond technology. It shapes hiring decisions, organizational design, and the willingness to continually adapt as both the business and the industry evolve.
Throughout our conversation, Gina described the difference between Openly and many larger organizations with a simple analogy.
“We’re like the speedboat. Larger carriers are often like the cruise ship. Neither approach is right or wrong, but being smaller gives us the ability to adapt much more quickly as the industry changes.”
For Gina, that adaptability has become one of Openly’s greatest strengths.
The industry will continue to change. Modern claims organizations need to be built with the expectation that they will change alongside it.
Key Takeaway
Technology will continue to reshape claims operations, but Gina’s perspective suggests the bigger opportunity lies in how organizations respond to that change.
As administrative work becomes increasingly automated, the value of technical expertise, sound judgment, and customer communication continues to grow. Building a modern claims organization therefore requires more than introducing new technology. It requires designing teams, operating models, and processes that help adjusters succeed in a more demanding claims environment.
At Openly, that philosophy has shaped the organization from the very beginning. Experienced adjusters remain at the center of the operating model, while technology reduces repetitive work and gives them more time to focus on the decisions and conversations that matter most.
What Claims Leaders Should Prioritize
Claims will continue becoming more complex, even as technology makes parts of the job easier.
Gina’s experience building Openly’s claims organization from the ground up offers a practical framework for navigating that reality:
- Hire adjusters with the expertise and empathy increasingly complex claims demand.
- Build ownership around the customer experience.
- Use technology to strengthen judgment rather than replace it.
- Create processes that are flexible enough to evolve alongside both the business and the industry.
Modern claims organizations won’t be defined by the technology they adopt alone. They’ll be defined by how intentionally they combine technology with the people and operating models that allow great claims professionals to do their best work.
Learn More
As claims become more complex, giving adjusters more time for the work that requires expertise and judgment becomes increasingly important. Learn how Kyber helps carriers modernize claims correspondence so adjusters can spend less time on repetitive tasks and more time serving policyholders.
