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Utilizing Artificial Intelligence (AI) in Healthcare Insurance to Transform Risk Assessment, Claims Processing, and Fraud Detection

Manoj Kumar

Concepts IT Inc

ABSTRACT - Artificial Intelligence (AI) is changing the face of healthcare insurance by innovating key operations such as risk assessment, claim processing, and fraud detection. By applying advanced algorithms in machine learning, insurers are able to reach a more accurate risk profiling and thus offer personalized insurance pricing based on individual health conditions and lifestyles. AI-powered automated claims processing enhances operational efficiency, shortens processing time, and minimizes errors. Additionally, fraud detection systems powered by AI proactively identify suspicious activities and save insurers and policyholders from financial loss. The paper discusses the various dimensions in which AI is making an impact on the health insurance ecosystem, highlighting the potential benefit to insurers through cost savings and improved decision-making while offering customers speedier services and personalization. The paper further points to some key regulatory challenges that will need consideration in terms of data privacy, algorithmic transparency, and ethical considerations to ensure equity and compliance in the adoption of AI technologies in health insurance.

Keywords: Artificial Intelligence, Health Insurance, Risk Profiling, Claims Processing, Fraud Detection, Pricing of Insurance, Machine Learning, Regulatory Challenges, Data Privacy, Operational Efficiency