AI Usage Case Study in Healthcare and Health Insurance Sector
DOI:
https://doi.org/10.71222/7ep7ng12Keywords:
predictive analytics, customer experience, risk assessment, claims processing, fraud detection, data privacy, machine learning, personalization, ethical considerations, transparency, automation, health management, chronic disease, data security, consumer trust, algorithmic governanceAbstract
Artificial Intelligence (AI) has become a transformative force in the healthcare and health insurance sectors, offering innovative solutions to improve efficiency, reduce costs, and enhance patient care. This paper examines four key applications of AI in health insurance and long-term care, analyzing their impacts from the perspectives of insurance companies, healthcare providers, and health service users. The paper highlights the role of AI in automating prior authorization processes, streamlining claims management, and providing personalized care recommendations. It also explores AI's application in high-risk pregnancy management, where predictive analytics and continuous monitoring contribute to early detection of complications, improving maternal and fetal health outcomes. Additionally, the paper discusses the challenges of ensuring AI system reliability, transparency, and fairness, as well as the importance of regulatory frameworks in maintaining patient safety and equity. By showcasing real-world case studies, this paper demonstrates how AI is revolutionizing healthcare delivery, improving operational efficiency, and ultimately enhancing the patient experience.
References
1. A. Bohr and K. Memarzadeh, Artificial intelligence in healthcare, 2020. ISBN 978-0128184387.
2. J. Singh and S. Urolagin, "Use of artificial intelligence for health insurance claims automation," in Advances in Machine Learning and Computational Intelligence: Proc. ICMLCI 2019, Springer Singapore, 2021, pp. 381-392, doi: 10.1007/978-981-15-5243-4_35.
3. A. D. Stern, A. Goldfarb, T. Minssen, and W. N. Price II, "AI insurance: how liability insurance can drive the responsible adop-tion of artificial intelligence in health care," NEJM Catal. Innov. Care Deliv., vol. 3, no. 4, pp. CAT-21, 2022, doi: 10.1056/CAT.21.0242.
4. Y. Mishra and A. Shaw, "Artificial Intelligence in the Health Insurance Sector: Sustainable or Unsustainable from the Lens of Ethical‐Legal and Socio‐Economic Standards," in The Impact of Climate Change and Sustainability Standards on the Insurance Market, pp. 57-74, 2023, doi: 10.1002/9781394167944.ch4.
