Using AI in the Health Insurance Industry
Though the buzz around AI technology is building and savvy new use cases appear daily, the insurance industry is built on managing and forecasting risk. In some cases, the AI technology in insurance isn’t new. Most insurance carrier AI focuses on providing solutions in two primary areas: internal operations and external customer experience. Examples of how the insurance industry uses AI technologies in both areas are included below:
AI Technology in Insurance Operations
- Proactive claims prediction: machine learning algorithms predict the likelihood of health insurance claims based on a policyholder's health data, helping insurers allocate resources and manage risk more effectively.
- Automated claim processing: AI can analyze health insurance claims and automate tasks to process each faster and more accurately, reducing the need for manual intervention, lowering administrative costs and improving efficiency.
- Claims outcome prediction: running historical claims data through AI algorithm analysis can predict the likely outcome of a claim, helping insurers make informed decisions and manage resources efficiently.
- Health monitoring: AI-powered wearables and devices collecting personal health data can analyze and generate real-time care insights, providing health insurers with details to create personalized healthcare offerings and recommendations.
- Fraud detection: identifying patterns of fraudulent behavior with AI allows insurers to detect and prevent fraudulent claims more systematically, helping eliminate bias and subjectivity.
- Risk assessment: AI can analyze a wide range of data, including medical history, lifestyle factors, and demographics, to accurately assess an individual's insurance risk profile and determine appropriate health coverage and premiums.
- Predictive resourcing: using that same data, AI algorithms analyze demographics, lifestyle factors, and medical records to predict future healthcare needs and costs, helping insurers plan and allocate resources effectively.
- Pricing optimization: data on healthcare costs and utilization can also be analyzed using AI to optimize insurance pricing, ensuring fair premiums that align with the actual risk and cost of healthcare services.
- Provider performance monitoring: using AI to track provider performance data helps insurance carriers monitor their network of healthcare providers, allowing them to more easily identify and maintain relationships with high-quality, efficient, and cost-effective providers.
AI Technology in Insurance Customer Experience
- Customer service automation: one of the simplest ways AI-power is used at health insurance companies is handling routine customer inquiries. Chatbots or AI apps provide quick and accurate responses to common health benefits questions, freeing up human agents to focus on complex issues.
- Virtual health assistants: AI-powered chatbots or virtual assistants also provide health insurance policyholders with instant access to personalized health information, quickly aggregating and guiding them through health insurance purchasing and care management tasks seamlessly.
“Self-service is a win-win for customers and organizations. 61% of customers would rather use self-service for simple issues.” - Salesforce ”State of Service Report”, 6th Edition
- Provider network optimization: AI algorithms can instantly analyze healthcare provider data to optimize in-network provider selection, ensuring policyholders have access to the most high-quality and cost-effective healthcare services covered as part of their health plan.
- Health literacy improvement: insurance carriers add value to their benefits packages by offering AI-personalized health education materials and resources to policyholders, improving users’ understanding of insurance benefits and health-related topics.
- Prescription adherence: AI can analyze medication data and patient history to identify potential issues with medication adherence, enabling health insurers to intervene and provide support to policyholders when necessary.
Insurance carriers can take advantage of KindHealth AI for help with all of these customer experience tasks, adding value and differentiating benefits from competitors. Check out a demo to see how.
Top Resources for Keeping Up with AI Technology in Insurance
As insurance carrier AI technology adoption grows and the health insurance industry adapts and evolves, there are a few trusted resources who continually track and report on the latest changes and advancements. Take a look some recommended resources for keeping up with AI technology in insurance and beyond:
- AMA Health Care AI - A section of the American Medical Association’s website focusing on the latest information in healthcare AI, matched with perspectives and statements from the AMA.
- EY AI Pulse Survey - This series by Ernst & Young, LLP explores AI technology advancements broadly, aggregating perspectives of senior leaders across many sectors, including healthcare and life sciences.
- Healthcare IT News, Artificial Intelligence - With an entire section of their website dedicated to following the latest in AI technology, Healthcare IT News is a great resource for keeping up with advancements in healthcare tech.
- Insurance Journal, AI News - One of the leading publications for insurance industry insiders, this section of the Insurance Journal website focuses exclusively on insurance AI technology news.
- InsurTech News, Latest AI News - Another industry-based publication closely following the latest trends and advancements in insurance AI technology specifically.
- The State of AI Annual Report - A comprehensive look at the overarching state of artificial intelligence in business by McKinsey, including adoption rates over time and breakdowns of functional use by department.
