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International Journal for Research Trends and Innovation
International Peer Reviewed & Refereed Journals, Open Access Journal
ISSN Approved Journal No: 2456-3315 | Impact factor: 8.14 | ESTD Year: 2016
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Volume 10 | Issue 12
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Impact Factor : 8.14
Issue per Year : 12
Volume Published : 10
Issue Published : 115
Article Submitted : 19459
Article Published : 8041
Total Authors : 21252
Total Reviewer : 769
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| Paper Title: | AI in Health Insurance: Optimizing Claims Processing and Fraud Detection |
| Authors Name: | Rohit Subhash Wani , Sayali Sanjay Jadhav , Sham Vijay Dede |
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IJRTI_202010
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| Published Paper Id: | IJRTI2504034 |
| Published In: | Volume 10 Issue 4, April-2025 |
| DOI: | |
| Abstract: | The rapid adoption of Artificial Intelligence in the health insurance sector is causing a revolution in claims processing and fraud detection. This paper describes how AI-based technologies, including machine learning, natural language processing, and predictive analytics, transform traditional insurance operations. AI technologies significantly reduce claims processing time and operational costs, with increased accuracy through automated validation and adjudication. The AI fraud detection system also analyses vast data to identify anomalies and suspicious patterns by which financial losses are mitigated due to fraudulent activities. The paper presents tangible benefits and challenges associated with AI adoption using a comprehensive literature review and case studies of leading health insurers such as HDFC ERGO and LIC Health Plus. The findings demonstrate AI's potential to enhance decision-making, optimize workflows, and improve customer satisfaction. The paper concludes by discussing ethical considerations and future trends, such as hyper-personalized insurance and advanced fraud detection models. |
| Keywords: | Artificial Intelligence (AI), Health Insurance, Claims Processing, Fraud Detection, Machine Learning, Natural Language Processing (NLP), Predictive Analytics, Automated Validation, Operational Efficiency, Anomaly Detection, Financial Loss Mitigation, Decision-Making, Workflow Optimization, Customer Satisfaction |
| Cite Article: | "AI in Health Insurance: Optimizing Claims Processing and Fraud Detection", International Journal of Science & Engineering Development Research (www.ijrti.org), ISSN:2455-2631, Vol.10, Issue 4, page no.a236-a245, April-2025, Available :http://www.ijrti.org/papers/IJRTI2504034.pdf |
| Downloads: | 000318 |
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2456-3315 | IMPACT FACTOR: 8.14 Calculated By Google Scholar| ESTD YEAR: 2016 An International Scholarly Open Access Journal, Peer-Reviewed, Refereed Journal Impact Factor 8.14 Calculate by Google Scholar and Semantic Scholar | AI-Powered Research Tool, Multidisciplinary, Monthly, Multilanguage Journal Indexing in All Major Database & Metadata, Citation Generator |
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Published Paper ID: IJRTI2504034
Registration ID:202010
Published In: Volume 10 Issue 4, April-2025
DOI (Digital Object Identifier):
Page No: a236-a245 Country: Pune, Maharashtra, India Research Area: Management Publisher : IJ Publication Published Paper URL : https://www.ijrti.org/viewpaperforall?paper=IJRTI2504034 Published Paper PDF: https://www.ijrti.org/papers/IJRTI2504034 |
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ISSN: 2456-3315
Impact Factor: 8.14 and ISSN APPROVED,
Journal Starting Year (ESTD) : 2016
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