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Understanding the Role of AI in Health Insurance

Team AckoJan 17, 2024

Computer Science has evolved over the years to perform multiple tasks at a much faster rate compared to humans. Machines are programmed to think like humans and imitate their actions. Artificial Intelligence (AI) in healthcare is a process of simplifying the lives of the people by predicting and diagnosing the illness at a faster pace compared to most medical professionals.

Apart from AI in healthcare, it is increasingly being utilized by the health insurance industry for an efficient and error-free experience. In recent times, the word ‘AI’ or Artificial Intelligence is fast gaining recognition among insurance companies to provide simplified tailor-made health insurance plans and services. Read on to learn more about understanding the role of AI in health insurance.




Role of Artificial Intelligence (AI) in Health Insurance:

When the distance between an insurance company and the customer reduces to zero with the help of technology, especially digital health insurance, there is a direct relationship between the insurer and the policyholder. AI has changed the way insurers are designing health insurance plans and help policyholders avail services quicker compared to traditional insurance.

To provide policyholders with accurate, instant, and efficient health insurance plans, AI is utilized by insurance companies to provide the best and tailor-made health insurance plan for customers. Mentioned below are the various roles played by Artificial Intelligence in the health insurance sector:

Use of Chatbots:

Chatbots are increasingly becoming an integral part of every organization, even healthcare institutions are taking advantage of the technology. Since most people have access to the Internet and smartphones, it is easier to use chat apps to interact with doctors, hospitals and insurance companies. It is available 24x7, making it more effective than human intervention. It uses sentimental analysis and natural language processing to understand customers' query better and provide answers on different types of questions related to insurance claims or selection of insurance products.

Faster Claim Settlements:

One of the biggest challenges for both policyholders and insurance companies is the turnaround time to settle health insurance claims. This could be because of large manual processes or fraudulent claims. Manually identifying genuine claims takes time and effort. However, AI can play a major role in the future to reduce the turnaround time for claims. AI can identify fraudulent claims, and it will learn from historical data to enhance the efficiency to a large extent.

Personalized Health Insurance Policies:

Insurers can identify and design a health insurance plan for an individual based on their historical data and current health conditions. This will help the insurer to provide a suitable health insurance plan instead of offering a health insurance package that may or may not be effectively used by customers. Also, customers will be encouraged to choose a plan suitable to their needs and not pay for healthcare services which they might not utilize.

Cost Efficiency:

Insurers are using AI to recommend preventive healthy habits and behaviors to customers such as exercise and nutrition, thereby reducing the cost of preventable healthcare expenditure arising due to unhealthy habits.

Fraud Detection:

Researchers are developing machines to analyze health insurance claims to predict cases of fraud. This also helps insurers to settle genuine claims quicker.

Speedier Underwriting:

The underwriting process in health insurance is cumbersome and time-consuming. However, with the advancements in technology such as smart wearable technology, devices such as fitness trackers are able to store and analyze large data and share the same with insurance companies. By utilizing this data, insurers are able to find new ways to underwrite customers differently. Health insurance companies are able to save time and costs by utilizing predictive analysis by AI.

What is Artificial Intelligence in Healthcare?

Artificial Intelligence in healthcare is the process of performing multiple medical-related tasks at a much faster pace, to predict or diagnose illness/injury efficiently so that the right medical treatment is provided to the patient. AI is able to gather information, process it, and provide the right output to the user. This results in the reduction of the time taken to diagnose illnesses and errors, thereby drastically cutting down the diagnosis-treatment-recovery cycle.

For example: If you choose to opt for online consultation with a doctor, healthcare professionals or organizations are using ‘chatbots’ to gather basic information before you can have an appointment with the doctor. This helps the doctor understand the issue before he/she begins the consultation process. Thereby reducing the time for both the doctor and the patient.

Benefits of Artificial Intelligence in Healthcare:

Even as the healthcare industry is moving rapidly towards digitization, there is bound to be massive data being generated and collected. This will only add a burden to healthcare professionals, since more the raw data, more the work. AI can read these data for healthcare professionals and patients and provide insights based on the data. It is a more efficient method of assessing illnesses. Mentioned below are the benefits of AI in healthcare:

Decisions Based on Clinical Observation:

AI is able to crunch large amounts of data and provide real-time, essential data that can help diagnose patients and advice treatments accordingly. By analyzing patient data and delivering results in a matter of a few minutes, it translates into better healthcare services at a lower cost. A good example of this is diabetes or blood sugar devices, which can analyze the data instead of just reading out raw data and notify trends based on the data provided, thereby allowing you to take immediate or corrective actions.

Increase in Accessibility:

While developed countries are able to provide healthcare to most of the population, developing countries may find it difficult. This is due to the fact that they are behind in terms of technology in healthcare, which has resulted in the decline of the health index of the respective country. Reaching healthcare to people living in the remotest corner is certainly a challenge and the prospects of healthcare deprivation increases. AI can help mitigate this issue by creating an efficient healthcare system. Digital healthcare will help bridge the gap between developing and developed countries since it will help the population to understand symptoms and receive the required treatment on priority.

It Helps Reveal Early Illness Risks:

AI is able to analyze large medical data of the patient and accumulate it in a single place. It can use the data to analyze the previous and present health problems. Doctors are able to use the data to compare and make an accurate diagnosis to provide the right treatment. With massive data in one place, healthcare apps based on AI can analyze a wide range of symptoms, diagnosis and probably predict illnesses that a person can have in the future. 

Early Detection of Illnesses:

Data such as diagnosis, medical reports and images can be used by AI to educate itself. Over the course of time, this learning will help diagnose the onset of illnesses and warn customers to take precautions and necessary steps to mitigate the consequences.

Saves Time and Costs:

Reducing time and easing the process to examine and diagnose an illness is another benefit of Artificial Intelligence. Instead of waiting for the consultation with the doctor to assess your illness, AI will be able to analyze and provide accurate inputs to the doctor, so that the doctor can make the right decision, thereby, reducing time to provide early treatments. With AI able to read and analyze the illness, people may not have to visit different laboratories for diagnosis.

Streamlining Processes:

AI can help reduce the administrative burden of physicians by streamlining appointments, translating clinical notes, or tracking patient notes and treatment plans. The advantages of AI in healthcare are several since it streamlines the various processes in a lesser time and provides accurate data.

Enhance Drug Development:

Developing drugs can sometimes take a lot of time and can even miss deadlines before pharmaceutical companies are able to provide the right formula. However, with AI, the development of drugs has never been faster than ever before. It helps scientists focus on developing drugs which are promising and are relevant to the requirements in the treatment of illnesses. It reduces time and costs in developing drugs which can be lifesavers in times of need.

Impact of AI in Healthcare:

Healthcare in India is highly complex and difficult to understand when it comes to analyzing data and patients sometimes pay the price for the same. By utilizing AI in healthcare, it can increase productivity and the effectiveness of treatments. It can also help healthcare professionals to spend more time in providing the right care and thereby reducing burn out of the medical practitioners. Below are the ways of how AI will impact healthcare:

  • Access to healthcare in developing or underserved countries.

  • Reduction in the burden of electronic health records.

  • Reducing the risks of antibiotic resistance.

  • Faster insurance claims.

  • Personalized health insurance plans.


Artificial Intelligence in medical insurance is well-suited to perform tasks which are generally done by humans at a lower pace. AI is able to analyze and evaluate massive amounts of data to streamline and simplify health insurance procedures. Artificial Intelligence’s influence on health insurance will reduce time and save costs for policyholders and insurers alike. Repetitive tasks will be performed by AI, while insurance professionals can concentrate on the procedures to streamline policyholder’s experience. AI will be able to simplify the lives of patients, hospitals, doctors and insurance providers by performing tasks that are generally done by humans, but will be much faster and cost-effective.

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