Payers embraced AI to modernize processes in the past. But now there is even more untapped opportunity to harness AI to turn human potential into superhuman power and humanize healthcare in the process.
Our analysis reveals that AI and intelligent technologies could save up to 55% of a health payer’s workforce capacity, and a deeper dive into specific roles reveals even more significant opportunities. The roles with the most potential savings (and therefore the most freed-up capacity) are underwriters (95%), claims processors (78%) and care coordinators (90%). With AI continually learning and technology advancing, capacity shifts analyzed to date are only the beginning.
For a large health plan (10 million members), saved capacity across all roles could unlock about $1 billion in value.
An injection of agility and speed
Unlocking this capacity can give the payer workforce “superpowers.” Remember Spider-Man®? A radioactive spider bites Peter Parker, giving him speed, agility and “spider sense.” His new life of fighting crime begins. This is a story about a person who realizes his potential and does meaningful work after (literally) being injected with technology.
When AI is “injected” (metaphorically) into ways of working across the payer workforce, employees can be liberated from more tactical and mundane work. They can be redirected to more strategic tasks, tapping into previously unavailable internal and external data for more insight-driven ways of working. This can translate into new products and services that improve service and member health while supporting new growth strategies for the business.
With AI superpowers, the workforce can provide better experiences to all stakeholders.
Consider how AI superpowers several key health payer roles — sales and account management, member enrollment and call center representatives:
Sales and account management
Put intelligence into salespeople’s hands—insight based on history, utilization trends or industry comparisons.
Focus on providing seamless experiences and advisory services that include proactive and personalized recommendations about plan options.
Call center representative
Transform this customer-facing role and increase the value that call center representatives provide by using AI-powered chat bots.
With great power comes great responsibility
These examples demonstrate how AI can shift work and experiences. But what of the $1 billion in extra capital that can be unlocked when payers superpower their workforce?
By putting this capital back into the business, payers can think and act like startups. They can invest in innovative ways of doing business differently, building new operational agility and challenging long-held industry practices. These actions can position payers to improve health access, experience and outcomes by harnessing the power of technology and human ingenuity.