AI set to revolutionise health insurance with personalised solutions

Yet another year of transformation, with technology anchored through artificial intelligence (AI)-skewed innovations, has passed for the health insurance industry. AI is way beyond being a buzzword; it is a force that drives newer ways of providing smart, quick, and truly customer-centric solutions that are genuinely changing how insurers do business.

In India, AI in health insurance is smoothing the process of risk assessment, fast-tracking the processing of claims, and protecting against fraud, among other things, with the rapid adoption of all things digital. Here’s how AI is revolutionising the sector.

Underwriting Revolution

Traditionally, underwriting has been a manual and paper-based operation. Today, AI writes this narrative anew. Powered by the analysis of Big Data-both historical and real-time-AI models provide unparalleled insight into an individual’s health profile.

The level of detail enables the insurer to determine risk more effectively and also develop policies appropriate for customers. For customers it means fair pricing and policies more suited to their needs. What took weeks is now completed in hours, which means increased efficiency and higher customer satisfaction.

Claims Processing

Claims processing is a known pain point for customers, generally slow and filled with potential areas where errors can occur. The traditional approach in manual adjudication entails verification of a claim, data extraction, and making a decision—a rather time-consuming process. AI changed this landscape: the processes of data extraction, its validation, and further decision-making became automated.

AI-powered systems today process claims in real-time, reducing the turnaround time at an exponential rate. Obviously, customers do not need to wait for long, as claims are efficiently settled, and transparency enhances customer trust. Real-time claim status updates further raise customer experience, providing assurance at critical times.

More than speed, AI makes the settlement of claims accurate. Since the intervention of humans is drastically reduced, reducing errors, one gets fair evaluations. Besides pleasing customers, it is a means to improve one’s prestige as a reliable insurer.

Fraud Detection

With the tremendous increase in the volume of digital transactions, fraud seems to be growing. Insurers and customers suffer heavy financial losses due to claims made through fraudulent means. The solution to this lies in AI.

AI algorithms analyse patterns in claims data and trigger notifications when they detect anomalies, which reveal potentially suspicious activities. Continuous real-time monitoring of data means insurers can flag potential fraud well before a claim actually begins processing. This approach will save not just money but also retain the confidence of genuine customers.

Due to the power of learning and adaptation that AI possesses, fraud detection systems are in continuous development. By being aware in advance of the evolving tactics of fraudsters, insurers ensure that their operations are conducted with integrity and customer experience is frictionless.

Improving Consumer Engagement

AI is not only changing the way firms operate but has also been defining a new paradigm of customer experience. The engagement of insurers with their customers is changing drastically with the use of AI-powered chatbots or voice assistants.

Health insurers now deploy AI chatbots integrated into their customer app. They are available 24/7 to resolve routine queries efficiently. These tools immediately assist and reduce queues; hence, customers get the necessary help at the right time. Similarly, AI-powered voice bots improve phone-based engagement with quicker and more precise responses.

AI also shows deeper insights in terms of customer behaviour and preference. It can analyse data on the customer, thus allowing an insurer to look ahead of needs and deliver products and personalised services. This proactive engagement makes interaction meaningful and responsive as it would enhance relationships.

The Future

As AI advances, so will its role in health insurance. In the future, it shall perform tasks ranging from the management of complex claims to the delivery of dynamic policy offers. Additionally, it is real-time insight and adaptive solutions that will be critical factors in the reconstitution of customer experience for health insurance, making it more accessible and aligned with individual needs.

AI’s ability to predict health risks, coupled with recommending prevention measures, would help improve customer well-being. In turn, insurance providers would be able to offer additional value-added services much beyond traditional coverage, encouraging proactive health management.

Embracing the AI-driven Future

In the modern world, AI adoption is no longer discretionary for insurers but rather a question of survival in the rapidly changing dynamics of the market. Embedding AI across all spheres of operations can help health insurers bring in efficiency, better customer satisfaction, and more precise risk assessment.

The future of health insurance lies in embracing AI-driven innovation. While we have been adapting and changing continuously, our efforts have focussed on creating intelligent, efficient, and customer-centric solutions that keep the health and well-being of every individual at the forefront.

With AI as a very powerful ally, the journey ahead promises to be truly transformational, not only for insurers themselves but also for customers, who stand to benefit from smarter, faster, and more personalised services.

Views are personal. The author is Anand Roy, MD & CEO, Star Health and Allied Insurance Co. Ltd.