Technology and Health Insurance Claims: How Digital Tools Are Streamlining Settlements – ET HealthWorld

By Siddharth Singhal

Today’s digital world might heavily bank on technology, but actually, it’s the experience that you create with technology that matters after all. Especially, when you are dealing in a sensitive industry like insurance, technology should be so seamless that it fits like a missing piece of the puzzle. With growing healthcare needs and the blistering pace of medical expenses, health insurance offers semblance to individuals in the form of a promise for a financially secure future. This is why claims are often dubbed as the moment of truth in insurance because ultimately everything boils down to this moment when the claim is honoured.

It comes as no wonder that in recent times, the intersection of technology and health insurance claims has witnessed a remarkable transformation. The experience that customers get at the time of claims is what they’ll remember the most, and therefore, digitisation is rapidly amping up claims assistance to create a seamless experience. Traditionally, the days of tedious paperwork, time-consuming processes and broken customer experience plagued the health insurance industry. With the advent of digital tools, insurers and policyholders alike are experiencing a significant shift towards streamlined, efficient, and transparent claim settlements.The evolution of health insurance claims

Historically, claim settlement involved cumbersome physical paperwork and manual intervention at every step of claim processing. No wonder, this led to frequent delays, errors and even rejection. That changed, with the rise of digital tools like Electronic Health Records, mobile apps, data analytics, AI/ML and end-to-end facilitation of digital submission and processing. The fear that previously deterred most consumers from buying health insurance was either the delay in claim settlement or its rejection altogether. With tech innovation and enabling regulatory reforms by the IRDAI in recent times, claims processes are a lot more simplified and accelerated. The rapid adoption of automated claims processing continues to make way for a seamless customer experience.

Digital submission and automated processing

Mobile apps have come to the rescue of the modern customer for almost everything. It’s only natural that they have become a powerful tool for something as crucial as claims processing. Policyholders can now quickly submit claims, and upload documents, pictures and any other paperwork digitally. This has eliminated the dependency on physical availability and presence to get all this done. This has also brought down the turnaround time significantly. Tracking has also become far easier as these apps provide real-time updates on the claims status, guaranteeing better transparency and customer service.

Predictive analytics and fraud detection

Insurers are increasingly using predictive analytics to anticipate healthcare trends and make informed decisions regarding policy pricing and coverage. It also proves to be highly useful in detecting and weeding out fraudulent claims. Voice analytics, face recognition and health records not only help identify fraud but also classify potential high-value claims. Advanced data analytics and machine learning algorithms can analyse vast amounts of data to identify suspicious patterns and anomalies in claims. All of this collectively helps streamline claims processing and also safeguards the interest of customers with genuine claims.

Transformed customer support system

AI-powered chatbots and virtual assistants are increasingly becoming a common occurrence. The primary conversation can seamlessly happen and customer’s doubts can be answered without any wait time. Only if it gets stuck in complicated questions, will human intervention be needed. Not just this, for customers preferring human touch, industry players are also adopting technology like screen-sharing to create a lifelike experience. Policyholders can interact virtually with the advisors and avail of support that they might need with uploading documents or claims submissions.

Connecting the dots with electronic health records

One of the key advancements in health insurance claims is the adoption of EHRs or electronic health records. This has greatly helped maintain accurate and updated records of a patient’s medical history and their health records. This information comes in handy for insurers who can digitally access it and expedite the entire process. This also leaves no room for human error and brings in greater operational efficiency. Besides, the connectivity among different healthcare systems and touchpoints allows for seamless sharing of data, ensuring that all parties involved have access to the necessary information.

The integration of digital tools into health insurance claims has revolutionised the health insurance industry. Right from faster processing times to improved accuracy and transparency, consumers are benefitting from tech innovation. In this digital age, the collaboration between technology and health insurance is not just a necessity but a game-changer that will continue to reshape the landscape of claim settlements for the better.

Siddharth Singhal, Business Head – Health Insurance,

(DISCLAIMER: The views expressed are solely of the author and does not necessarily subscribe to it. shall not be responsible for any damage caused to any person/organisation directly or indirectly).

  • Published On Dec 16, 2023 at 01:57 PM IST

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