The Transformation of Healthcare Insurance through Digital Tools and AI

Jiaming Zuo

Authors

Jiaming Zuo Everbright Actuarial Consulting Limited, Hong Kong, China Author

Keywords:

healthcare insurance, artificial intelligence, claims processing, predictive analytics, data privacy, customer experience

Abstract

The integration of digital tools and artificial intelligence (AI) is transforming healthcare insurance by enhancing operational efficiency, improving patient engagement, and enabling better health outcomes through data-driven approaches. Key innovations such as AI-powered claims processing, fraud detection, wearable health monitoring, and telemedicine platforms contribute to more personalized and accessible healthcare services. However, challenges remain, including data privacy concerns, algorithmic biases, and the importance of maintaining human-centered care. Looking forward, the sustainable adoption of AI and digital technologies depends on continuous innovation, ethical considerations, and close collaboration among insurers, technology providers, healthcare professionals, and regulators. Together, these efforts can build a healthcare insurance system that is not only efficient and effective but also compassionate and equitable.

References

1. S. M. Devaraj, “AI and cloud for claims processing automation in property and casualty insurance,” Int. J. Eng. Technol. Res. (IJETR), vol. 8, no. 1, pp. 38–46, 2023, doi: 10.5281/zenodo.14498802.

2. J. Machireddy, “Automation in healthcare claims processing: Enhancing efficiency and accuracy,” Int. J. Sci. Res. Arch., vol. 9, no. 1, pp. 825–834, 2023, doi: 10.30574/ijsra.2023.9.1.0435.

3. G. Pisoni and N. Díaz-Rodríguez, “Responsible and human centric AI-based insurance advisors,” Information Processing & Management, vol. 60, no. 3, p. 103273, 2023, doi: 10.1016/j.ipm.2023.103273.

4. L. P. Serrano, K. C. Maita, F. R. Avila et al., "Benefits and challenges of remote patient monitoring as perceived by health care practitioners: a systematic review," Perm. J., vol. 27, no. 4, p. 100, 2023, doi: 10.7812/TPP/23.022.

5. E. Peterson, D. Shatin, and D. McCarthy, "Health services research at United HealthCare Corporation: the role of the Center for Health Care Policy and Evaluation," Med. Care Res. Rev., vol. 53, no. 1_suppl, pp. 65–76, 1996, doi: 10.1177/1077558796053001S05.

6. K. P. Patil, M. S. Kulkarni, and M. Hudnurkar, "Enhancing service quality in the insurance industry with AI-powered humanoid chatbots," TQM J., 2024, doi: 10.1108/TQM-11-2023-0354

7. J. Torous, "A path towards progress: lessons from the hard things about digital mental health," World Psychiatry, vol. 21, no. 3, p. 419, 2022, doi: 10.1002/wps.21003.