Application of Artificial Intelligence in the Health Insurance Claims Management Process

Abstract

The increasing number of business clients and insured individuals in the insurance sector is leading to a growing volume of health insurance claims, necessitating more efficient administration processes. One solution is to automate these processes using artificial intelligence (AI) tools, which can handle repetitive tasks, reduce the likelihood of errors, and ultimately increase customer satisfaction. AI tools enhance efficiency by streamlining workflows, enabling employees to focus on more complex and strategic tasks. They can process large volumes of data quickly and accurately, which reduces the time spent on manual data entry and analysis. This increased efficiency not only improves service quality but also enables companies to attract more business clients. The primary issue identified is the rising demand for employees and increasing administrative costs, prompting a search for innovative solutions. The purpose of this study is to propose suggestions on how the application of artificial intelligence tools in the health insurance claims administration process would help automate processes, increase the efficiency of the claims administration structural unit, and encourage new sales in companies operating in the insurance sector. To achieve the goal, the following research tasks were set: to review how the scientific literature analyzes the application of AI tools in the operational processes of an insurance company; using expert assessment, to find out which claims administration processes can be automated by applying AI tools, and what impact this would have on the claims administration process and the attraction of new business customers; to evaluate alternatives for how the application of AI tools in the health claims administration process would help increase sales to new business customers. The study includes a literature review, expert assessment, and evaluation of alternatives. Based on the empirical research results, it was found that AI tools create the prerequisites for reducing the process time from a few minutes to seconds, making it possible to settle a larger number of claims within the same time unit. Accordingly, the insurance company can attract more new customers and ensure that customers receive a better experience in administering their claims and communicating.