--Medical record review is a classic bottleneck in the insurance process. It's labor-intensive, time-consuming and prone to human error. Early attempts at automation in insurance couldn’t handle the unstructured documents associated with claims.
--The changemaker is today’s AI workflows. They use algorithms that can read, understand and categorize data and route relevant details to people-powered checkpoints and specialized analysis (for example, a physician expert reviewing medical records previously sorted or indexed by an AI). The result is up to 70% faster claims processing, smoother workflows and more accurate results.
--And the "paperwork revolution" is just beginning.
Paperwork backlogs in insurance have evaded even the savviest of technology solutions. In particular, the processing of unstructured medical documents or cabinets filled with claims data was difficult to automate, so many have kept doing the work by hand.
Now, the technology landscape has changed.
AI has been getting plenty of buzz, and it’s no secret why. The rise of artificial intelligence and machine learning tools has made it possible for humans to accelerate everything from legal proceedings to test prep. However, one of the more powerful uses for AI is often overlooked: processing paperwork.
That might not be as glamorous as a robotic law firm or a self-driving car, but AI’s superhuman ability to sift through pages could well and truly change the game in claims.
More paperwork, more delays
Paperwork is tedious. In claims, it’s also unavoidable. When everything from a patient’s previous medical history to the lead-up to a claim requires documentation, the pages add up. The insurance industry is cautious by nature, so paperwork needing high attention to detail usually gets it—which can lead to time-consuming workflows and a backlog of files.
Medical record review is a classic bottleneck in the insurance process. It's labor-intensive, time-consuming and prone to human error. Early attempts at automation within insurance, such as automated underwriting or telematics, couldn’t handle the unstructured documents associated with claims. However, relying on manual processes leads to unhappy customers and workflow delay.
This junction between people and programs is where AI can truly transform. Combining automated workflows and expert input offers accurate results, fast. Removing the manual labor from the medical recordkeeping process isn’t just about making offices virtual (although AI can certainly help); it also means processing medical information in less time. This can do more to improve the customer and patient experience than even the best AI-powered service tools.
Humans join the loop
The real changemaker is today’s AI workflows, which don't eliminate human brainpower. With people-powered checkpoints and specialized analysis (for example, a physician expert reviewing medical records previously sorted or indexed by an AI), processing more data doesn’t come at the cost of professional expertise. AI tools use algorithms that can read, understand and categorize data, identifying relevant details and making these details easier to retrieve. This means up to 70% faster claims processing, smoother workflows and more accurate results.
Automatically extracting information from medical records means medical experts and claims handlers can make informed decisions fast. This not only reduces costs for providers but also results in quicker payouts for policyholders, something that could benefit both sides of the bottom line—boosting insurer revenue and lowering cost.
Unlocking the potential of AI
The paperwork revolution is only beginning.
Today's insurance customer expects a swift, smooth experience from their provider and expects the experts involved in their file review, including physicians or legal professionals, to do a thorough and accurate job. Meeting these two needs in a reasonable amount of time necessitates technology.
When documents can be processed, sorted, indexed and organized faster than a human can, it opens the door for the expert to pay more attention to each file. This expedites the decision-making process, improving the experience for everyone involved.
Winning the case on claims processing
The paperwork involved in medical records review is a major hurdle in claims. With a combination of technology and expert inputs, it’s now possible to do more in less time—but what does this mean for insurance as a whole?
The entire industry can enjoy the benefits of smoother document review. Accuracy is essential in complex claims, where small details can add significant hours to a file or alter the outcome of a case. Automating the task of document sorting and indexing makes better use of expert time—so claims can be reviewed both faster and more thoroughly.
Historically, insurers have been reluctant to move away from a manual workflow. Insurance is an industry based on details, and the complexity of the processes within it have led many organizations to delay the change. Still, there’s no better time than now.
The potential benefits of automation are significant both in terms of hours and cost. The impact AI may have on customer satisfaction could be sizeable, as insurers that can process claims faster and more accurately have a competitive advantage.
The future belongs to those who are willing to innovate—and in terms of medical record review, AI presents an opportunity for insurers to do just that.