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Healthcare Industry August 24, 2023

From Risk Assessment To Claims Management: How AI Is Changing The Insurance Games

Medically Reviewed by Nkese Onoko

Written by Adaobi Oduenyi

Making Insurance Smarter: How is Technology Changing the Game?

Imagine this: you're sitting at your desk looking at a huge stack of paperwork knowing that you not only have to go through them but you still have to span out how much to charge a business for its staff HMO.

You're flipping through thick manuals, jotting and calculating down numbers, your head is starting to spin and all you can think about is Why me who did I offend? I can imagine you just sweating picturing this one scenario, so just take a deep breath because help is on its way and it's technology, in the form of Artificial Intelligence (AI).

Now, you might be thinking, "Wait a minute, isn't AI that stuff from sci-fi movies that has all those soulless robots taking over everything? How's that going to help me with making my insurance work easy?" Well, my friend, buckle up because we're about to dive into how AI is changing the game, making things smoother, quicker, and dare I say, even a bit exciting in the world of insurance.

“Picture this, Imagine an AI-powered image recognition technology stepping in to quickly assess the damage to medical equipment or facilities. This means claims can be processed much faster than before. And that's not all – and when you throw algorithms that understand human language into the mix.“

What is Risk Assessment and why is it powerful?

Risk assessment is the process of identifying, analyzing, and evaluating potential risks. It is powerful because it can help organizations identify and mitigate risks, which can save money, time, and resources. Risk assessment can also help organizations to comply with regulations and improve their overall safety and security.

Risk assessment can be used in a variety of situations, including:

  • Business planning

  • Project management

  • Safety and Security

  • Health and environmental protection

Risk assessment can help organizations to:

  • Identify potential risks

  • Evaluate the likelihood and impact of risks

  • Develop and implement controls to mitigate risks

  • Monitor and review risks

Risk assessment is a very important part of effective risk management and it can help organizations make informed decisions about how to manage risks and protect their assets.

The magic of risk assessment is that it can help organizations turn risks into opportunities. By identifying and evaluating risks, organizations can develop strategies to mitigate the negative consequences of risks and maximize the potential benefits.

Risk assessment is a powerful tool that can help organizations improve their performance and achieve their goals.

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Remember those days when figuring out insurance risks meant wrestling with mountains of data? Those days are fading fast, thanks to the recent developments in technology specifically AI.

Artificial intelligence has the amazing ability to go through loads of data in the blink of an eye. It can look at all sorts of data, from historical trends to real-time numbers and help insurers span out the nitty-gritty details of risks.

You know those actuarial tables you had to interpret are basically child's play for AI algorithms. And guess what? Insurers are reporting that they're cutting down the time it takes to span out risks by up to a whopping 90%! That's like going from being in standstill traffic on the third mainland bridge to zooming through the third mainland bridge during election season.

Claims Management: Getting Sorted Efficiently and Swiftly 

The old-school process of managing claims used to be a real hassle, involving lots of manual steps, going through lots of documents, and requiring a lot of human effort. This will become a thing of the past because AI's knack for spotting patterns and predicting outcomes will definitely shake things up especially when it comes to health insurance.

Picture this, Imagine an AI-powered image recognition technology stepping in to quickly assess the damage to medical equipment or facilities. This means claims can be processed much faster than before. And that's not all, and when you throw algorithms that understand human language into the mix. They are helping pull out the important info from claims documents and other medical records, making decisions in a flash.

According to McKinsey, insurance companies that have brought AI into their claims process have seen a whopping that have brought AI into their claims process have seen a whopping 30% decrease in how long it takes, making customers happier with faster settlements.

AI can also be used to identify patterns in claims data that would be difficult for humans to see, which can help insurers detect fraudulent claims more quickly and efficiently.

In fact, a survey conducted by McKinsey and Company in 2021 that polled over 550 insurance executives globally, found that 70% of respondents believe that AI will have a significant impact on their business in the next five years. The most common areas where respondents expect AI to have an impact are:

  • Claims processing: 75% of respondents believe that AI will improve the efficiency and effectiveness of claims processing.

  • Underwriting: 72% of respondents believe that AI will help them to better assess risk and price premiums.

  • Fraud detection: 69% of respondents believe that AI will help them to detect fraudulent claims.

  • Customer service: 67% of respondents believe that AI will help them to provide better customer service.

  • Product development: 65% of respondents believe that AI will help them to develop new products and services.

The survey also found that even though insurance companies are still in the early stages of adopting AI. However, the vast majority of respondents (89%) believe that AI will be essential for their business in the future.

Improving Customer Experience

Let's be real, Dealing with insurance can sometimes feel like talking to a robot. But now, AI is flipping the script on that one. Say hello to chatbots and virtual helpers. These little AI buddies are like your personal insurance sidekicks. They answer your questions, guide you through claims, and give you all the information you need. It's like having a friend who knows all about insurance (minus the constant billing).

And here's the scoop: Insurance bigwigs are betting on AI to give customers VIP treatment. They're saying that AI is going to change how we interact with insurance, making it way more user-friendly and, dare I say, fun. Imagine getting all your questions answered without having to listen to elevator music, constant ads and then worrying about your airtime being sucked dry, that's the AI promise.

A little Caution: It's Not All Rainbows and Sunshine

Now, before you start to think that artificial intelligence is the perfect solution or as an all-knowing powerful tool you will need to exercise a little caution.

Yes AI is super awesome, but you still need to keep in mind that AI  learns from things that's happened before. And if any of that stuff has some biases in it, AI would most likely pick up on those too. This means we've got to be extra careful to make sure AI isn't being, well, unfair.

Oh, and what about our jobs? Will AI steal them all? Not so fast. Yes, AI can zap through numbers and data with the snap of a finger but always remember that there are still things that only humans can do such as; understanding feelings (being empathetic), solving tricky problems, and just being human. So, while AI's great, let's make sure we humans still get to bring our A-game to the insurance table.

Wrapping it Up

There you have it, a brief glimpse into how AI is shaking up the insurance world, from crunching numbers to getting claims sorted in a snap. It's like having a tech-savvy partner who's got your back, making things faster and smoother.

Just remember, while AI's awesome, we've got to keep an eye on fairness and make sure we humans stay right in the picture too.

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