Are you still booking a doctor’s appointment in the regular method or are you living in the smart era and using AI to book the same? AI is slowly turning into a regular part of our lives and it’s definitely for the better, However, when it comes to Insurance it’s surely turning around the regular operational landscape. 86% of executives say AI will be a mainstream technology. While the Insurance industry is aggressively adopting AI in their operations, the TPAs who have long been serving the Insurance industry need it more than ever to streamline their operations. Keep reading to explore more!
How AI can Transform the Claims Process for TPAs?
AI is transforming the regular claims processes with its robust capabilities that can help insurers tap into crucial processes. There are several opportunities for AI to enhance and redefine the claims process.
Here’s a closer look at them:
These are the opportunities that are increasingly lying for the insurers and TPAs as AI in insurance continues to tap into these individual processes. Firstly, AI is changing the nature of claim administration by challenging where human interactions and judgments are required. AI is significantly transforming the claims management process by:
Auto Adjudication
By leveraging AI, simple claims can be processed instantly without the requirement of a claim adjuster. The AI uses images and documentation and seamlessly automates the claim adjudication process.
Cost Reduction
AI significantly lowers the cost of administering claims by reducing labor costs, improving margins for TPAs, and saving costs for their clients.
Administrative Efficiency
Another one of the significant areas where AI is truly proving to be impactful is improving administrative efficiency. AI significantly enhances the non-claims tasks such as contact center operations, improving metrics like average handle time (AHT) and creating more capacity.
How Can AI Prove to be the Changemaker in the TPA’s Operational World?
While AI will be challenging the TPA market, it will also be offering opportunities for a large pool of TPAs who need to take advantage of the opportunity. With the TPA market growing at an annual compound rate (CAGR) of 8% over the last five years, AI in claims management will further contribute to this growth significantly.
Here are the three key opportunities that AI can help TPAs tap into to offer great value to the insurers:
Provide Data and Analytics Services
TPAs have the opportunity to leverage AI in their own operations and offer valuable insights to insurers. With this, they can specifically focus on offering data on what is driving claims for insurers to offer better underwriting experience in the future. Insurers have long struggled to gain insights in this area.
Embracing the Complex
One of the significant areas where AI will be helping the TPAs is to help them in embracing the complex. Leveraging AI, the TPAs can significantly lower the volume of claims that require claim adjusters.
Additionally, it will also highlight the need that insurers, managing general agents (MGAs), employers, and others in the insurance ecosystem will have the expertise to process the most complex claims. Thus, the TPAs will possess the expertise to manage these claims and will be in a market position to increase their market share.
Loss Prevention Services
We are living in an era where the severity and the frequency of claims are increasing and understanding how to mitigate or even potentially prevent claims will be offering even more valuable insights, both to the TPAs and to their clients. TPAs who gain insights from their data and actively engage in root cause analysis on behalf of their clients can seamlessly develop business units that are focused on loss prevention.
Why Understand the Need for AI in TPA Operations?
The TPA market has historically been controlled by large insurers, and this goes specifically for TPAs who are serving the large insurers and employers for claims administration who have been able to keep entrants out due to their size. With AI, there is a change in this, and AI’s ability to successfully help the traditional TPAs to meet their unique needs. This was once an expensive capability which is now significantly becoming more affordable due to technical innovations.
Conclusion
AI is transforming the way TPAs work especially in claims management. By leveraging advanced AI technology, TPAs can not only improve their operational efficiency but also explore the areas in their operations that were previously unimaginable. With the rapid adoption of AI, TPAs can significantly connect better with Insurers and establish a stronger relationship.
