Solution for Insurance: Claims management journey.

AI will be a BIG win for the insurance industry. ⚡️ But why should you care?

Deep dives into claims management, care management, and customer service show how (Gen)AI enhances operational efficiency, boosts customer satisfaction, and reduces claims costs for health insurers. These areas should be prioritized for (Gen)AI deployment due to their significant business potential. At the same time, health insurers should start with applications that meet four key criteria—value, feasibility, risk, and strategic alignment—for valuable early experimentation with (Gen)AI.

Based on our project experience, (Gen)AI is already solving everyday problems and reducing costs in medical invoicing management. (Gen)AI enhances claims verification through smart algorithms and shortens lengthy claims settlement negotiations, for example, by selecting the most effective negotiation strategy based on historical settlements. In addition, applications support health providers and patients in submitting claims to insurers by reducing errors and communication loops due to false or incomplete data. By integrating (Gen)AI into payment processing, complex billing processes and payment delays can be reduced. For example, BCG worked with an Asian health insurer to build and implement a (Gen)AI audit co-pilot application to reduce manual documentation and unlock efficiencies. Within just 10 weeks, the co-pilot tool was tested and fully implemented, ultimately reducing the manual writing and documenting processes for auditors by up to 50%. Ultimately, end-to-end leveraging of (Gen)AI applications in claims processes will thoroughly change current operations and unlock significant efficiency gains.

Author

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