Health insurers are constantly trying to find a balance between rapid claims decisions, keeping customers happy, and giving each claim the time and attention needed to reduce fraud.
With insurers paying up to $750,000,000 in annual reimbursements on complex claims, the smallest error margins are very costly.
Sprout.ai is empowering health insurers to process claims faster and more accurately using the power of Artificial Intelligence. It seamlessly integrates with pre-existing systems, enhancing the customer experience without sacrificing accuracy or leakage detection.
We take a closer look at how Sprout.ai can enable insurers to transform their claims processing workflow.
Read more: How Sprout.ai reduces fraud and waste in insurance claims
Challenges facing the health insurance sector
The healthcare industry faces unique challenges when it comes to claims management.
Inconsistent documentation
On average, each health insurance claim typically includes 3-5 pages of documentation. This usually isn’t standardised in format, with one provider supplying a receipt, another an invoice, and a third a letter.
Manually reviewing this documentation can take hours, sometimes even days. There is also a much higher risk of human error.
Shortages of skilled claims handlers
Due to a skills shortage, insurers are struggling to recruit the number of claims handlers necessary to process claims.
These claims handlers also need lots of time in order to review, analyse, and validate each claim before making an accurate decision. In a fast-paced sector like health insurance, time is a luxury they don’t always have.
Lack of access to data
The necessary data for claims handling is often held in spreadsheets, making it much more difficult to analyse.
Claims handlers have no choice but to deal with this inaccessible data, adding to already large workloads. This means they are forced to make decisions based on 1 or 2 pieces of data rather than the full picture, which leads to less accurate decisions.
How AI can be used in claims management
Artificial intelligence (AI) is an umbrella term, referring to all technology that seeks to intelligently automate processes that would otherwise be done by humans.
Generative AI is one type of AI, and is used in insurance to streamline claims handling. It does this in part by automating complex workflows and analysing large datasets.
By leveraging generative AI, insurers have the option to dedicate more time to more complex claims.
Long-term, this improves customer satisfaction, reduces claims processing times, and improves accuracy, all while keeping company costs down.
Improved document handling
Sprout.ai addresses the issue of lengthy and inconsistent documentation by recognising over 450 types of documents. It is also able to standardise medical codes, enabling efficient and accurate claims processing.
With Sprout.ai, there is no such thing as a language barrier. A handwritten note in Japanese will be handled with the same ease as a hospital invoice in the UK.
Reduced leakage
Insurers are constantly faced with a choice: thoroughness or speed. By prioritising the former, they are spending more time, more money, and putting their relationships with customers at stake.
However, focusing on efficiency means opening themselves up to fraud, as it reduces the amount of data that can be reviewed and increases the chance of human error.
Sprout.ai extracts all relevant information from documents, contextualises relevant data, and then validates it against the policy contracts.
This speeds up the process without compromising on accuracy.
Boosted staff retention rates
Without the assistance of Sprout.ai, claims handlers tend to spend 70% of their time manually reviewing and analysing documentation — only 30% is spent handling claims.
47% of claims handlers say reviewing documentation is the most tedious part of their role. Sprout.ai improves staff retention by allowing them to focus on the more specialised aspects of the role.
More informed decision-making
Sprout.ai is able to quickly review all data and documentation to make a comprehensive decision on a claim. This expedites the claims process and improves accuracy, strengthening relationships with customers while keeping business costs low.
Sprout.ai is also able to consider average costs for different medical treatments and procedures regionally. This enables Sprout.ai to identify discrepancies more effectively and provide more informed underwriting.
Room for a human touch
Some insurers might worry about AI using a ‘one size, fits all’ approach to claims handling.
Sprout.ai’s deep learning algorithms use your company’s claim handling philosophy. This guarantees the best possible outcome for the insurer and customer.
By handling simpler claims, Sprout.ai allows claim handlers to focus on complex health insurance claims that need a human touch and high levels of expertise.
Better customer relationships
Customers have come to expect efficient, hassle-free models in everything they do. Insurance is no different.
While 21% of customers want claims settled within hours, 43% find themselves waiting over two weeks.
By improving data analysis, document verification, and policy checks, insurers can feel confident that their claims are being handled accurately and with attention to detail, without sacrificing the customer experience. Sprout.ai delivers up to 99% accuracy, giving insurers peace of mind and customers the claims experience they want.
Read more: How automated claims processing enhances customer experience
Enjoy smarter claims handling with Sprout.ai
Sprout.ai helps ensure that healthcare claims processes aren’t just handled efficiently, but accurately.
From expert data handling to leakage reduction, Sprout.ai empowers insurers to focus on complex claims. You can feel confident in the knowledge that simpler claims are being processed with care, attention to detail, and accuracy.
The health insurance industry is under immense pressure year-round to provide compassionate support to customers around the world, often at very vulnerable times.
With Sprout.ai, you can make sure each customer receives the care they deserve, and that your business continues to grow and adapt to an ever-changing industry.
If you’re ready to take your insurance business to the next level, book a demo with Sprout.ai today.
