AI in Healthcare Payers: How to Respond and Rewire Your Organization
Healthcare payers create networks, define rules, set prices, and process payments—tasks that artificial intelligence (AI) can execute well, with the right direction. It’s frequently enough said that AI-driven automation increases efficiency, while lowering administrative and medical costs. That’s true, but it’s also fairly obvious.
Let’s dig deeper: How can AI change the way work gets done? And how can payers do more for their members?
At a typical payer, McKinsey estimates that 65% to 80% of jobs are transaction-oriented, like claims processing. Almost all of these could be fully automated. Another 10% to 25% of jobs require knowledge, such as pricing actuaries and medical management clinicians.The remaining jobs, including sales, are relationship-oriented. While automation potential is lower for these,generative AI (gen AI) can boost productivity in both knowledge and relationship-oriented work by as much as 50%. It can handle tasks like looking up facts, cleaning and collating data, taking notes, and writing proposals.
Another way to look at the payer workforce is by roles. “Do-ers” are individual contributors who perform day-to-day tasks. “Deciders” are executives and managers who set strategy, allocate resources, provide approvals, and ensure good governance.The rest—about 10% to 15%—are “interpreters.” These roles, including project coordinators and