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Healthcare insurance is a critical component of the healthcare industry. Health insurance companies today are leveraging Artificial Intelligence (AI) to pinpoint at-risk individuals better and to reduce costs in ways not possible before. The applicability and opportunity it offers to the insurers are fantastic. AI comprises a broad range of applications that make the system smart enough to work on data to automate machines, provide forecasts, or derive actions which itself is the use cases around hospital claims management. It also enables deriving conclusions from complex issues and makes informed decisions. The majority of AI use-cases and emerging applications for the health insurance industry appear to fall into two main categories; cost efficiency and fraud detection.
AI approaches aim in successful intervention toward fully automated background processing so that administrative employees can focus more on cases that require review. Smart audit algorithms enable reliable identification of claims that are fraudulent. AI is used to identify unusual claims which help determine the likelihood of successful intervention. The system learns with every new request received.
To improve the current status of the claim process run by multiple employees, AI-based chatbots can be implemented. A touchless insurance claim process, driven by AI can remove excessive human intervention and can update the system and communicate with the customer all by itself. With an effortless process, clients can file their claims without much hassle. Before sending to the bank for claim settlement, AI-powered claims bot can review the claim, verify policy details and pass it through fraud detection. Clients can either type or use voice command to communicate their concerns relating to different policies and chatbots can process to deliver personalized solutions for those queries. Chatbots can also do a lot more including product recommendations, promotions, lead generation, and customer retention.
Insurance bots can automatically skim thru customers general economy, social profile to identify their living patterns, lifestyle, risk factors, and financial stability. AI's capability of critical observation of data can predict the amount of risk involved and stay away from frauds, hence give customers justified insurance amount.
Insurance companies are required to devise an enterprise-level strategy to implement AI in such a way. Intelligent health insurers with their optimistic eyes are reaping full benefits of AI.