Human Resource Outsourcing

How AI can transform health care benefits administration

Healthcare is undoubtedly an expensive sector and for employers, providing effective healthcare benefits can be a costly and resource-intensive effort. A major chunk of the expenses, around 15-25 per cent, goes towards administrative costs. Employers are constantly looking for ways to ease both the costs and efforts involved in providing healthcare benefits. This is where artificial intelligence (AI), machine learning (ML) and automation show immense promise. 

AI is revolutionising various sectors, and one area where its impact is particularly transformative is healthcare benefits administration. The complex nature of benefits administration, coupled with the sensitive nature of healthcare data, makes this sector ripe for AI integration. AI can streamline processes, enhance accuracy, reduce costs and improve decision-making, ultimately leading to more efficient and effective healthcare benefits management. AI tools can also provide insights to members or employees so that they can make sound decisions while choosing healthcare benefits.

AI is also transforming the broader field of healthcare administration. AI-powered tools can analyse vast amounts of healthcare data to identify trends, predict future healthcare needs and improve patient outcomes. For example, AI can analyse patient data to identify individuals at high risk of developing chronic conditions and recommend preventive measures to reduce the likelihood of these conditions developing.

Here is a more detailed discussion about the role of AI in healthcare benefits administration.

  • Reduce administrative burden
  • AI tools can process large volumes of data, so administrative tasks, which would otherwise be time-consuming, can be performed quickly and save both cost and time. Administrative overheads can be reduced and the team can instead focus on enhancing the client experience. AI and ML, along with automation, are being increasingly incorporated for their abilities to:

    • Verify eligibility of employees automatically
    • Recommend options depending on organisational requirements and employee needs
    • Analyse rates of utilisation
    • Create the best benefits plan after considering all the relevant factors

    AI can also improve the overall efficiency of healthcare benefits administration. Advanced AI models can make personalised recommendations to employees so that they can choose the most cost-effective coverage plan. For example, AI-powered chatbots can assist employees in understanding their benefits packages by answering questions and guiding them through enrollment processes. This not only improves the employee experience but also reduces the burden on HR departments, allowing them to focus on more value-added tasks.

  • Implement predictive analytics to optimise costs and predict disease risks
  • AI tools powered with predictive analytics insights are adept at identifying cost patterns and trends. For example, during flu season, AI algorithms can analyse data and predict which members are most likely to skip their flu shot and raise the possibility of future ER visits and thereby, costs. Administrators can then use such information to educate and encourage members to get vaccinated at the right time.

    Similarly, predictive models can help mitigate certain disease risks too. For example, individuals with a risk of developing chronic conditions such as diabetes, heart conditions and chronic obstructive pulmonary disease (COPD) can be identified and encouraged to seek the right care. Benefits administrators can design healthcare plans that take into account all such relevant facts.

  • Unlock and harness data using generative AI
  • Advances in generative AI (Gen AI) enable benefits administrators to make greater use of all the data available. Some AI tools are becoming more powerful by learning on their own. This allows them to analyse information relevant to administrators, answer their common questions, and even uncover hidden insights or trends that administrators might not have considered.

    Self-service analytics tools can be utilised even by individuals who have no experience in data mining or statistical analysis. The availability of such adaptive data at the right time allows administrators to design and streamline benefits plans and processes more efficiently.

Benefits administration: Looking ahead

Overall, AI has the potential to revolutionise healthcare benefits administration by improving efficiency, reducing costs, and enhancing the overall employee and patient experience. Furthermore, AI can help in fraud detection and prevention. By analysing patterns in claims data, AI can identify potentially fraudulent claims and alert administrators, helping to reduce costs and improve the overall integrity of the benefits system.

As AI technology continues to advance, organisations can expect to see even greater benefits in the years to come. The next wave of ML and Gen AI will further transform the industry. The future promises more cost savings, better user experience and member-centric care, all of which will benefit both employers and employees. 

Another key area where AI is making a significant impact is in benefits administration outsourcing. Many organisations outsource their benefits administration to third-party providers to reduce costs and improve efficiency. AI can enhance these outsourcing services, reduce the risk of errors and free up human resources to focus on more complex and strategic aspects of benefits administration.

How can Infosys BPM help?

Infosys BPM’s Benefits Administration Outsourcing offers a comprehensive suite of services designed to streamline your employee benefits administration. This includes retirement plan solutions, compensation data management, and robust claims processing. Our claims management service encompasses everything from seamless communication with all parties involved to efficient administrative support. Additionally, we handle health and welfare benefits administration along with a wide range of other critical services to ensure a smooth and efficient benefits experience for your employees.

Recent Posts