Four crucial ways AI streamlines health benefits administration

A strained healthcare workforce combined with the rising cost of care continues to burden health provider organizations. Artificial intelligence (AI) is fast emerging as a solution to bridge resource gaps and enhance care. Health benefits administrators are already experiencing AI’s advantages, which are dramatically reducing administrative workloads, automating entire workflows in claim determinations, and helping to enhance health equity.

AI provides data analytics capabilities that enable benefits management to be more efficient and personalized for both agents and claimants. Benefits teams can take inspiration from within the healthcare industry as well as from other markets with similar processes and data challenges, including retail, transportation, and more—anyone with a diverse customer base and a need to manage invoicing and claims.

From chatbots to compliance management, these are the top four AI use cases in practice today delivering value in benefits planning and administration:

1. Customer engagement and experience: AI powers platforms that can help customers find answers quickly and improve health outcomes. Chatbots provide relevant assistance in multiple languages while virtual agents provide the first touch with patients to assess healthcare needs or guide patients through the benefits enrollment process in real-time.

Personalization is a central benefit that patients want, and AI can deliver. Global digital healthcare company, Kry, uses AI to analyze vast amounts of patient data to steer patients between primary, urgent, and secondary care. This capability helps patients feel in control of their healthcare journey and enables providers to treat more patients effectively.

Use cases from other market sectors, such as retail, apply to improving customer experience in healthcare. Data can capture how patients prefer to interact with healthcare providers and, just as importantly, where bottlenecks or obstacles occur, whether it’s with care or with claims. Using AI to track and analyze user information provides insights to increase loyalty and confidence.

2. Workflow automation: AI streamlines benefits management processes in two ways. First, by automating routine tasks such as communications and document routing. This ensures that critical deadlines are met and enables agents to focus their time and energy on more strategic activities.

Second, AI is exceptionally good at managing and finding correlations in massive amounts of data. The algorithms are designed to analyze and prioritize documents based on their content and context in a fraction of the time it would take a human to do so.

Capturing and classifying the data itself can be an overwhelming task. AI tools can sort and extract information from structured and unstructured data sources such as driver’s licenses, X-ray images, and financial documents. Automating this process eliminates manual data input, which reduces errors and saves time.

For benefits managers, this translates to a more complete picture of each patient, and less time spent hunting for every required bit of information. The result is often faster claims processing and thousands of labor hours saved.

3. Claims processing and decision support: AI tools quickly spot mismatched or incorrectly entered information across huge data sets—a task that could be near impossible for humans to accomplish quickly, if at all. AI’s speed and scalability exponentially increases throughput, as it did for Consumer Direct Care Network, which expanded its claims processing capacity from 3 million items to over 20 million.

As financial institutions and e-commerce companies have learned, AI algorithms can also detect fraudulent behavior, flag suspicious claims for further investigation, and expedite the resolution of legitimate claims, reducing administrative overhead and improving operational efficiency.

There is one other aspect to smarter, faster use of data in benefits management. By analyzing historical data, predictive analytics ensure agents anticipate customer needs and proactively address issues before they escalate, improving customer satisfaction and limiting costly, time-consuming efforts.

4. Compliance management: AI can help ensure that benefit plans comply with relevant laws and industry standards by monitoring regulatory updates and requirements in real time. AI-driven compliance management systems lift this ongoing burden from overworked benefits staff. These solutions automatically audit plan documents, flag potential compliance issues, and recommend corrective actions, keeping agents apprised of evolving regulations while minimizing the risk of penalties.

AI is helping healthcare providers worldwide meet the diverse needs of individuals and organizations, improving efficiency, easing resource limits, and ensuring better care. By harnessing the power of AI capabilities in day-to-day operations, benefits planners can make better-informed decisions leading to cost-effective healthcare for patients and providers alike.

Learn how Microsoft Cloud for Healthcare can help your organization empower your benefits agents through ethical AI technologies.