Aetna enlists AI to settle health insurance claims

The health insurer developed an artificial intelligence application to resolve claims, freeing up staff to focus on higher-level tasks, says CTO Claus Jensen, who plans to automate other processes.

Aetna enlists AI to settle health insurance claims
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Aetna has created artificial intelligence (AI) software to settle claims, a solution that could provide a blueprint for broader automation of complex processes at the health insurance giant. The software rapidly parses complex healthcare provider contracts, whose blend of information about medical conditions and financial data often tax the patience of the trained humans who process them.

“It really comes down to providing a better experience” for end users, says Aetna CTO Claus Jensen, adding that the software will help the company be a better partner in the health-care ecosystem for providers and patients. “We have to do more than just pay the bills and answer questions on the phone.”

It’s a significant development at a time when all manner of companies are grappling with how to solve business problems with AI and machine learning (ML) technologies. Worldwide spending on AI systems is forecast to reach $35.8 billion in 2019, an increase of 44 percent over the amount spent in 2018, according to IDC, which placed healthcare at No. 4 in spending on AI, behind retail, banking and discrete manufacturing.

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