How AI Chatbots Are Speeding Up Health Claim Processing?

Role of AI-Powered Chatbots in Health Claim Settlements

Traditionally, health insurance claim processing in India was complex and slow. It involved heavy paperwork and manual verification of medical records, fraud detection and assessment of eligibility before giving claim approval, which delayed the process. Here is how innovative AI-powered chatbots have streamlined the health claim settlements:

1. AI chatbots have automated claim submission by allowing policyholders to upload a digital copy of bills, medical reports and prescriptions.
2. An AI chatbot uses natural language processing (NLP) and optical character recognition (OCR) for real-time verification of documents.
3. AI algorithms detect fraud instantly by flagging suspicious claims and save insurers’ money by reducing fraudulent payouts.
4. AI chatbots provide round-the-clock assistance when it comes to claims and update you on claim status, reducing the waiting time.

Popular Insurance Chatbots in India

Here are the popular insurance chatbot examples in India and the crucial role they play in streamlining the health insurance claims:

ICICI Lombard’s MyRA

MyRA is ICICI Lombard’s AI-driven virtual assistant that assists the policyholders in the general insurance claim settlement process, including health insurance. You can initiate claim intimation, upload claim documents (such as medical prescription, discharge summary and more) and track your claim status. It also answers your claim-related queries and gives assistance on a real-time basis.

Medi Assist Matrix platform

This AI chatbot of a third-party aggregator platform is widely used for health claim settlements. Star Health Insurance has also partnered with Medi Assist to adopt this AI-led claims platform. Mainly, it automates the claim process by digital document upload, verification and fraud detection. This AI-chatbot-driven claims support helps the policyholders to get the claim settled quickly without hassles.

Acko’s AI-driven chatbot

Acko’s AI-powered chatbot provides simple solutions to complex claim-related queries. It helps in the faster settlement of health insurance claims by improving the efficiency of claim processing. This includes uploading the claims documents directly via chatbot, digital verification of documents, detecting fraudulent claims, and preventing fraudulent payouts. This not only enhances customer experience but also speeds up the settlement process.

HDFC ERGO’s AI chatbot

HDFC ERGO’s AI chatbot handles claim submission by assisting the policyholder with document uploads, verification and fraud detection. It also allows you to check the claim status along with real-time assistance on health claim processing. Streamlining the health claim settlement helps in a smooth claim settlement experience for customers.

Niva Bupa’s AI-led Chatbot

Niva Bupa’s AI-led chatbot supports health insurance policyholders in claim intimation, checking claim status, and answering health insurance-related FAQs efficiently without human intervention. It assists the policyholder during hospitalisation, from pre-authorisation to discharge settlement.

Let us say you have bought a health insurance plan on Jio Insurance Broking, an online platform that lets you compare policies from various insurers to make the best choice. You can still take help from the AI chatbot from that insurer for faster settlement of claims online.

As per the insurance regulator IRDAI (Insurance Regulatory and Development Authority of India), misrepresentation/discrepancy/fraud are the main reasons for health insurance claim rejection or delay in settlement. This is what AI chatbots are streamlining today, which can slowly reduce the rate of claim rejections or delays in future.

Reports suggest that AI tools like chatbots in India can resolve nearly 70% of simple health insurance claims on a real-time basis. This can bring down the operational cost by 30% to 50% and significantly increase the claim turnaround time.

The Road Ahead

As we move towards a technologically advanced future and the inclusion of universal health coverage, transparent and faster claim processing will become more important to boost policyholders’ trust. AI chatbots are not just streamlining the claim settlement process but also improving efficiency, transparency and preventing fraud. With increasing AI adoption, especially after the pandemic, AI-driven claims without any human intervention could soon become the industry standard.

Conclusion

To conclude, advanced tools like AI chatbots are reshaping the future of the Indian insurance landscape by speeding up the claim settlement process through automation. The customer-centric approach offers efficiency and accuracy to the policyholders by giving real-time assistance.