AI for Health Insurance Providers

Health insurance companies compete to provide policies for businesses and individuals alike. Using AI in health insurance can help companies provide useful information to prospective and current customers, while helping improve the actuarial processes and cost balancing decisions that make major medical plans work. is a medical AI software development company that is committed to developing affordable and custom artificial intelligence solutions for medical insurance providers to help improve enrollment and provide more effective care at better prices. Below are just a few examples of how AI will benefit health insurance providers.

Health Insurance Cost Estimators

Health insurance premiums make serious financial impacts. When individuals and especially businesses shop for a major medical plan, they need to make sure that the coverage they need fits into their available budget. Artificial intelligence can be used to develop stronger health insurance cost estimators that streamline the information acquisition process and leverage large amounts of data quickly to automate the calculation of initial estimates for premiums to allow individuals and businesses to consider their options.

More robust artificial intelligence systems can be integrated into back-end health insurance cost estimators used by health insurance companies to create the actual plans they make available for purchase. By using AI to automate the research and calculations in the actuarial work required to produce plan rates and policy adjustments, health insurance providers can provide more transparent cost information to prospective customers and offload some of the actuarial work that typically needs to be performed by specialists to streamline workflows and reduce costs in customer acquisition.

Healthcare Cost Estimators

Health insurance companies can also use artificial intelligence to improve the online services they provide to policyholders. Healthcare cost estimators can be integrated onto customer portals that will allow individuals to calculate the expected costs of a variety of treatment options. Artificial intelligence can be used to extract relevant data from the policyholder's electronic health records (EHR) to look for health care provider options for various conditions. This may be particularly helpful to estimate costs for seeing in-network or out-of-network specialists.

These healthcare cost estimators may also be used to allow the patient to make informed decisions about the best use of their money to address their health needs, by researching typical charges for services generally used to address their injuries, illnesses, and/or conditions in their geographic location using their provider benefits. AI chatbots with natural language processing can help address any specific questions customers may have about using their plan benefits. By empowering their policyholders to make more informed financial decisions about their health, health insurance providers can help control health care costs and ensure that the benefits they offer provide the maximum benefit for their customers.

Health Insurance Claims Management Software

Health insurance fraud is an unfortunate problem in the US, estimated to amount to about $80 billion a year across all lines. This winds up affecting policyholders as well as insurers, as premiums need to rise to accommodate any losses that won't be recovered from the legal process. In addition to fraud, sometimes health care services are not coded properly and need to be re-coded to ensure appropriate claims are met. Health insurance providers also typically have pre-approval processes for certain services that requires review before customers can proceed with care. Artificial intelligence can be used in health insurance claims processing software to streamline and automate data processing workflows to help health insurance companies respond more quickly to fraud, approve claims for loyal customers, and offer fast turn-around on pre-approvals for care, thus improving customer service while reducing costs.

About is a new division of DDA dedicated to making custom medical AI software development more affordable for health insurance companies and other medical organizations that can benefit from artificial intelligence solutions. Backed by a 25-year history of working for clients throughout the healthcare sector, understands what it takes to develop custom interactive software to meet the exact needs of each client. You may learn more about what AI can do to improve medicine by a further review of this website, or if there is a specific need you would like addressed, contact today.

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