Without a doubt, good health is one of the most vital necessities in life. Most people didn’t realize it until the recent COVID-19 pandemic though – the current scenario has reiterated the importance of being healthy and having the best possible healthcare accessible when you need medical care. It has also caused the health insurance industry to witness people buying more insurance than ever before to reduce their financial risk should they contract the virus, and this trend is likely to continue. The global health insurance market size is projected to grow at a CAGR of 25.4% between 2021-2026. 

Digital disruption has invariably affected the health insurance industry as well.  Several players in the industry are now leveraging the latest digital technologies such as Artificial intelligence (AI), Big Data Analytics, and the Internet of Things to customize their offerings, reduce cost, and enhance their customer experiences. As predicted by Accenture, the majority of insurance executives believe that artificial intelligence (AI) will significantly transform the industry, and McKinsey estimates that AI and Analytics will have a total potential annual value of up to $1.1 trillion if AI tech is utilized to its full potential in the Insurance industry.

In this article, we will look at how and where the healthcare insurance market is adopting Artificial Intelligence, and the multitude of value-adds it makes possible within the domain. 

Claim management

Reviewing and processing submitted claims is a time and labor-intensive task.  With Artificial Intelligence, insurance providers can make the claims management process faster and better, with fewer errors. Artificial Intelligence reduces human intervention by identifying and routing claims with the incorrect information for further evaluation by actual people, and routing submissions with correct information towards fully automated background processing.

AI-based claim management enables automated report generation, database updation for future reference, and communication with the end-user, ensuring seamless customer experience. A modern claim management platform leveraging artificial intelligence can help insurance providers optimize the claim management process.

Fraud detection & prevention 

Combating insurance fraud has always been a nightmare for health insurance providers. Artificial Intelligence is the perfect solution to this problem. Handling insurance fraud is a costly, time-consuming process if insurance providers rely on traditional methods. With the introduction of AI-based solutions, it is possible to analyze a humongous amount of data within the shortest possible time. AI-enabled systems can analyze entire medical histories without any hassle and identify patterns a human might overlook. When the system comes across any possible anomalies, it will be marked for closer scrutiny. With more data, AI-based systems will become more intelligent to identify which parameters or instances might be a fraud and which might not. However, even though artificial intelligence-based solutions are the best way to handle the quantity and complexity of data, human intervention is likely to remain a key element in making the final decision. 

Operational efficiency

The insurance industry is generating a massive amount of data, thanks to accelerated digitization. Health insurance companies have been storing this data on legacy systems that are often incompatible with each other. Stakeholders within the organization may work in silos, and this leads to substantial manual dependency as well.

Implementing AI-based systems addresses this issue by standardizing the data structures and reducing the manual effort for mundane, repetitive tasks. AI-based systems handle external data (client-focused) and internal data (process, operations, etc.) for insurers. By analyzing the available internal data, these systems help insurers develop risk mitigation and cost reduction strategies by optimizing their processes and standards. These systems can also be leveraged to assess the company’s performance and predict possible undesirable outcomes even before they occur. 

Personalized product offerings

Traditionally, insurance companies have designed their offerings based on the risk pools determined by statistical sampling. With dynamic consumer behavior, this “one-size-fits-all” approach for product offerings may not be efficient or sustainable. Though companies provide personalized offers such as critical illness coverage, heart disease coverage, etc., customization at an individual level is yet to be seen. 

AI can disrupt the insurance ecosystem by providing consumer behavior-based personalized product offerings. AI systems can analyze individual medical records ( age, gender, job nature, family health history) to personalize the product, the premium, and the coverage list. If integrated with IoT devices like smartwatches, fitness bands, and other wearables, insurance providers can predict and personalize insurance coverage for each unique customer.


The insurance industry is still in the nascent stage when it comes to utilizing the vast possibilities that artificial intelligence offers. With accelerated digitization and change in consumer behavior, the health insurance industry will witness increased adoption of AI-based systems to reduce costs, improve operational efficiency, and provide superior customer experience. The future of AI in healthcare insurance is to create a better health experience for all stakeholders. 

Experion Technologies has been providing AI-based solutions to enterprises across the globe to accelerate their digital transformation journey – we have built AI-based solutions such as automated claim detection using deep learning, automatic information extraction from claim forms and real-time emotion detection through facial expression analysis. Our team of experts in the insurance and healthcare industry enables organizations to craft better customer experiences and introduce innovative business models. 

To know more about our AI solutions, write to sales@experionglobal.com