The Blueprint

We use forms of Artificial Intelligence every day—from Alexa telling us the weather, to virtual assistants on websites, to Wall Street for stock trading. So, it feels natural that it will continue to permeate our lives and business sectors. One of the areas that AI has a huge potential to change is underwriting.

Most of us know that underwriting is a labor-intense process. Requesting the records, reviewing them and understanding the terminology takes hours. Attention to detail and the ability to identify both current and prospective patterns is key when aligning a patient’s or group’s health with the coverage they need. And any time humans are involved, there is a potential for mistakes—which can be costly in a number of ways.

That’s why artificial intelligence is so attractive—it eliminates the potential for human errors both on the underwriting side and the employer group side. When considering underwriting, many look solely at the integrity of the underwriter, but AI considers and accesses the integrity of the member, confirming information to detect fraudulent claims. AI can also review thousands of health records much faster than a human could. It also has the capability to identify patterns and pick up on terms that the humans reviewing might miss. While humans would need frequent training to stay abreast of specific trends, AI is constantly learning the algorithm and training itself. Additionally, AI could go on reviewing documents while the office is closed, and the underwriters are sleeping. This not only saves money but limits repetitive tasks and aids in improving overall worker productivity. Another additive to AI performance is the customer service aspect. No matter the time or day, members could access AI with questions or concerns via a chat bot feature, strengthening customer rapport. In short, AI enhances offering accuracy, speed, and even predicts future outcomes—establishing a layer of risk analysis we’d only dream of.

Of course, there are cons. AI is relatively unknown and therefore requires work on the front end to establish rules and behaviors. While humans need rest and can miss things, they have critical thinking and creative skills that AI cannot duplicate. There is an inherent value in a real person looking at the data to understand the employer group and its members—and AI just can’t replicate that.

However, the trend in the marketplace is certainly in the direction of leveraging AI to make every component of the healthcare ecosystem more efficient. At RMTS, we pride ourselves on partnering with you for the long-haul, and that means staying on top of industry trends. If you have questions about AI and its application to underwriting, reach out to us.