5 Steps to Build a Strong RFP for AI Claims Document Management

With RFI/RFP season in full swing, organizations are gearing up to draft compelling proposals that attract the right vendors and solutions. To make informed decisions, many start with a Request for Information (RFI) to gather market insights, assess vendor capabilities, and refine project requirements. A Request for Proposal (RFP) follows when organizations are ready to solicit formal bids based on defined criteria. 

RFIs and RFPs help organizations evaluate vendors and solutions before making a purchase or decision. While common in government procurement, RFIs and RFPs are also widely used in industries like insurance, healthcare, and enterprise technology. RFIs and RFPs for AI claims document management are especially relevant today, as the widespread adoption of enterprise AI platforms is relatively new. Creating a well-structured RFI or RFP can go a long way toward understanding the market and finding a solution that meets the organization’s compliance, security, and operations needs. 

Why RFIs and RFPs matter when choosing a vendor for AI claims document management

Drafting RFIs and RFPs can help improve decision-making, reduce risk, and assess competing vendors’ RFP. An RFI is used to understand what solutions exist on the market and refine the project scope; RFPs seek a tangible solution. Both RFIs and RFPs give the organization information on what types of solutions exist and which may be the most cost-effective, as well as potential roadblocks or market trends. 

Here’s how to build an RFP that attracts the right vendors. 

1. Define the project scope, and get a clear understanding of what the organization needs

Before drafting an RFI or RFP, clearly outline organizational requirements. Consider, 

• Project Goals: What specific problem are you solving with AI-driven claims document management?
• Workflow Automation: Which existing manual processes can be improved with automation?
• Budget Considerations: What solutions fit within your organization’s financial constraints?
• Compliance & Security Needs: Does your organization handle sensitive health, legal, or financial information? What privacy or regulatory standards must the vendor comply with (e.g., HIPAA, SOC 2, PIPEDA)?
• Implementation & Ownership: Who will manage the implementation—both internally and on the vendor’s side? What contingency plans are in place if key personnel leave during implementation?

Pulling this information into a template might look something like: 

Mapping Your Current Claims Document Workflow

Within your RFI or RFP, state the project’s background or project goals in terms of the work your agency does. Answer questions such as:

• How are claims documents currently submitted? (Paper, email, digital portal)

• Who processes these documents manually? (Claims adjusters, legal teams, etc.)

• What tools do you currently use? (Adobe, Excel, case management software)

• What are the bottlenecks? (Long processing times, difficulty finding records)

• What data security measures do you have today?

For example, a project summary for a state workers’ compensation board might state something like:

• Your organization processes various claims-related documents as part of adjudicating workers’ compensation claims. 
• Each claimant’s file may include medical records, employment documents, accident reports, insurer correspondence, and legal filings—all of which must be efficiently organized and processed to resolve the claim.
• All of these files are stored in PDF form in a secure digital vault, as required by your state oversight body. 
• Your organization hopes to automate the indexing of these files, as well as generate a medical summary of the patient to pass on when utilizing a medical examiner and adjudicating the file — it wants an AI claims document processor to take a 600 page PDF filled with disorganized medical documents into an indexed, searchable file for faster claims resolutions.

Organizations should also help the vendor understand some of your process for each file — for example, where does the claim originate? Where are applications reviewed (and by who?). What do you do once the claim is initiated? The project process in this example might look something like:

• Application is submitted by claimant online and reviewed by staff on the administrative team; eligibility is assessed in house and the claim is triaged for complexity before the medical documents are requested from various parties.
• The medical file is generated and associated with the patient’s name. Documents are received from relevant parties and stored digitally in large PDF files.

At this point, you’d like a vendor who can:

• Parse, sort, and organize patient documents for seamless searching and quick retrieval of key information or specific records.
• Generate an organized medical file, stored in the digital filing system, to pass on to an independent medical expert or examiner, as well as the adjudicating board.

Within the claim life cycle, the medical examiner's report will then be prepared for adjudication and the case will be reviewed by board members before being approved, denied, or delayed for further information. 

The specific agency writing the RFP may not cater to this area in the claims life cycle, however, it has laid out the process it uses and the work that’s required. By asking good questions and defining the project’s scope, it can gather critical information about which types of agencies are capable of pulling the project off. 

2. Outline technological requirements

Not all AI claims document management systems are created equal. When setting out technical requirements, be clear. In many cases, it’s a good idea to reach out to the individuals within your organization who will be using the AI claims document management platform. What are their needs? In the example above, the organization might tell potential vendors:

• How a document originates and what needs to be done with the file. For example: “Medical documents originate as a single 500-1,500 page PDF. These documents come from various state resources, as well as healthcare providers. Currently, the staff uses Adobe software to separate and organize the pdf file.”
• What the file needs to look like when it’s done. For example, “Our staff separate each document into its own folder, labeled with the source of the document. Within each folder, documents are numbered according to an index we created in-house.”
• What your organization requires in each file: that it pertains to the correct patient, is relevant, is correctly labeled with the type of file, is stored according to date and originating body, etc. 
• How the information is passed onto the next stage in the claims process: if the next stage is the medical report, are all documents sent to the examining physician? Do these documents require secure document storage in a certain jurisdiction? 

Clearly communicating your technical needs and specific requirements will ensure you filter out vendors who don’t align with your business goals. For example, you might add a checklist for technical capabilities, which looks like the below:

Technical Capabilities Checklist

• AI-powered document indexing

• Ability to process large PDFs (500+ pages)

• Document classification (medical, legal, administrative)

• OCR and text extraction with confidence scoring

• Integration with claims management systems

• Compliance with HIPAA (U.S.), SOC 2 (Global), and PIPEDA (Canada)

• Secure API connections for document retrieval

3. Highlight security needs and compatibility 

Organizations handling claims-related data—such as medical records, legal filings, and financial documents—must comply with regulations like HIPAA (for medical data), SOC 2 (for data security), and jurisdiction-specific insurance laws. Vendors should be able to demonstrate that they meet these standards. Your organization should also request details (both internally and from vendors) on the databases, data exchange programs, APIs, or onboarding software used.

In the example above, the company was trying to replace its manual workflow with an AI solution. Since the workflow was purely manual, the team in charge of the RFP might not be familiar with the company’s software for data exchange, security, or application management. It could, then, discover during the vendor selection process that additional integration costs are necessary to match the AI data management tool with the existing stack.

4. Ask questions about vendor support, training, and onboarding

Vendors should also be willing to share how they support your organization through the process of using their platform:

• How fast are response times? 
• If there is a problem, how quickly can it be resolved? 
• What does the onboarding process look like?

Training and onboarding is another process where vendor questions may be required. How much training will the vendor provide? Post-implementation support (like troubleshooting or customization) is also helpful, as reliable support systems and points of contact make sure that the system performs well over time and your team is well supported. 

When finding an RFI/RFP partner, your organization’s leaders and managers know your team best, including their training needs. How much support will they need in the onboarding process? Would they prefer in person training and virtual support calls, or written documents describing processes? Can the vendor meet these needs? 

5. Create an internal evaluation tool for vendors

A government organization, agency, or large enterprise will likely have a number of vendors competing for the contract. All of these vendors may meet AI claims document management needs. Among the decision makers on your team, you’ll need to decide which criteria are most important in a platform: vendor reputation, project efficiency, technology or innovation, user-friendliness, training methods or total cost.

Building an effective RFP requires clarity and a transparent process. With a clear vision of your needs and a detailed outline, you’ll be set up for success when shortlisting vendors. Ultimately, the solution you choose for AI claims document management will help transform the processes and day-to-day work at your organization. By taking the time to create a thoughtful and transparent RFP, your organization can select a solution that best fits its needs.