In today’s tech-driven world, artificial intelligence (AI) has made deep inroads into our economy. In the health insurance industry, AI has already shown it’s not just a resource optimization tool or a passing fad. It is here to stay and become a core part of the payer industry. AI is all prepared and equipped to
disrupt the market, right from claims to distribution to underwriting as policy price and purchase enter the real-time mode.
With the prevailing pandemic confining people indoors, the demand for contactless and at-home services has exploded. This gives AI a perfect platform to play a bigger role. AI is gaining strength with a new wave of deep learning techniques. Such advancement will pave the way for insurance to switch gears from detect and repair to predict and prevent, revolutionizing every aspect of the process.
In this second blog of a three-part series, let’s see the primary use cases of AI in insurance. You can read the first one here.
1.Faster claim processing
There can be multiple factors responsible for delays in claim processing. For, it involves a chain of tasks including review, investigation, adjustments, remittance, or denial. The possibility of human errors cannot be ruled.
-Manual processing: This involves human interactions and comes with a high risk of errors.
-Different data formats: Many a time, customers send data that may not match the one that the company and employees have, resulting in a waste of resources and time.
-Dynamic regulations: Insurers have to quickly align their policy framework to keep pace with changing policies. It calls for constant updates of resources, especially software and training staff. Any loophole at any stage can cause an error.
2.Automated cost estimation
Cost estimation can also be taken into automation mode. Some AI systems read and understand pictures/X-ray/reports and bills and offer a real-time estimation cost. When this technology is fully applied, the cost estimation process can become over 10 times faster.
3.Accelerated appeals processing
Many claims result in appeal when both the involved parties- customer and insurer- do not find themselves on the same page. AI can come into play here in speeding up the process using the latest tools. Some of the tools available
in the market claim that they can automate 89% of appeals processing with a 99% accuracy rate.
4.Faster application processing
Piles of documents, number crunching, reasoning and analysis, too many complex tasks are involved in application processing once the data is extracted. And, this data is always voluminous. Both, the room for error and the time consumed in the process are huge. The answer to overcome this issue can be found in AI-powered automation. It can ensure error-free data extraction and also expedite the insurance application process. The end result again is a satisfied customer base.
Workflow in business operations can be reduced drastically with machines processing all the customer profile details including lab reports, biometric data, patients’ medical history, claim data, and come up with the right pricing and best insurance plan. AI-generated suggestions and reports, based on various data collected, can be a guiding point for both customers and insurers in finding the right products. It can be based on the customers’ own choices in the past or the general trend emerging from overall data.
6.Easy document creation
Document and data compilation is the backbone of health insurance companies. The volume of every insurer is high and the requirement is specific. Often a key information is buried under a huge volume of data. It is no surprise that creating these documents is time-consuming and prone to human errors. Besides being menial, this type of work often affects the morale and performance of the workforce. Be it policy statements, other information or general profiling, AI produces faster and accurate results. Documentation automation in the long run is affordable and easy.
Gone are the days when a customer would wait to raise a query or claim for office hours to begin. An affordable and fastest way to be available to customers 24×7 is AI technologies. Besides, these tech tools can also help attend to customers across time zones, irrespective of geographical locations. Chatbots are increasingly getting popular across a wide spectrum of businesses, and health insurance is no exception. Machines, no doubt, are yet to come to a level where they can replace the communication skills of humans, but they are ‘matured enough’ to keep customers engaged till the time the staff take over the matter if it remains unresolved.
False and fraudulent claims are not new for the insurance market. But now the technology is available to detect it much quicker and in the simplest ways. AI-powered tools can detect fraudulent claims based on the company’s
regulations and policies combined with data and reasons provided by the claimant. Predictive analytics and text analysis help in achieving this.
Customized services are the best way to cut through a cut-throat competition. It is more so in demand in the post-Covid-19 world. We can safely say that no survey is required to know that most of the customers today want personalized services. With AI, insurance companies can understand their customers better and offer customized products so that an individual pays only for the coverage he/she needs.