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The Nairobian

Insurance platform bets on Artificial Intelligence to ease claims processing

Enterprise

By Nanjinia Wamuswa | Apr 10, 2024

**M-Tiba Head of Pricing and Portfolio Management Shadrack Kiratu.** [Nanjinia Wamuswa, Standard]

Health insurance technology platform M-Tiba has integrated Artificial Intelligence (AI), into its insurance claims processing system - reducing claim approval times to hours.

The firm says implementation of AI technology, and in particular Machine Learning (ML) models, enhances efficiency and fraud management resulting in lower administrative and healthcare costs for health insurers. This allows health insurers to offer more affordable health insurance products to their customers.

“The AI solution is seamlessly integrated into our claims assessment process. This new system enables us to expedite claims reviews significantly,“ said M-Tiba Head of Pricing and Portfolio Management Shadrack Kiratu.

“This innovative technology, developed and tested over the past three years, complements our existing systems, automating claim approvals without requiring manual review for each submission.“

Currently, over 40 per cent of the claims can be automated. The AI technology approves claims upon submission, allowing claims assessors to concentrate on more complex evaluations.

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Over the last three months, M-Tiba has employed technology to automatically assess claims for leading health insurers, facilitating faster payments to providers and improving their cash flow.

“Previously, manual claim reviews prolonged the approval process as traditional technologies are not scalable. With AI technology, we can automate claims assessment at a scale, enabling our insurance clients to grow faster and our team to focus on more complex claims requiring additional expertise,” noted Kiratu.

According to the Association of Kenya Insurers report, the industry has witnessed increased claims frequency, which could become burdensome and expensive if insurers fail to embrace technologies such as AI for claims processing.

Regulations require insurers to admit or deny liability, determine amounts, identify claimants, and make payments within 90 days (about three months).