How automation is simplifying insurance claims analytics in the US


From moving through heavy traffic to catch the physician for appointment to getting consultancy while driving to the office, from searching for the prescribed medicine to ordering it online, and from looking for better care at the hospital to getting it at home- Healthcare has changed multifold in the last couple of years. 

But amidst that progress, claims analytics are still a field that needs consideration. The automation provided within the insurance claims analytics in the US is paving the way for better business models and patient care. Things are starting to revolutionize as far as claims are concerned. 


Medical claims are one of the toughest parts to deal with in the healthcare industry. The claim processes and eligibility criteria pose a whole new set of challenges with valid and invalid deductions. It required tonnes of paperwork and functional communication lines. This problem can be solved with data analytics automation. The process of predictive analysis can help identify claims that have high-defense pricing. This helps in simplifying the entire claims processing with accurate data. The predictive analysis is the part of the automation where real-time sharing and update of claims is done. 


There is various customized software offered by digital healthcare solutions providing companies. These are intended to provide and predict the claim approvals by comparing them with the actual claimed value. This way, accuracy can be improved with a precise claiming process through insurance claims analytic. Some other ways this can help include:

  • Predicting future claims

  • Checking the history of claims

  • Testing claim data

  • Insurance comparison

  • Pending claims management

  • Factors comparison

  • Eligibility checking

  • Claim generation records

  • Data management of claims


Automation is also playing an important role in fraud detection. In a country like the US, 70% of patients are concerned about the authenticity of their insurance providers. They feel worried about the frauds. This mindset needs to be changed, and insurance claims analytics is a major factor. It helps by:

  • Detecting improper insurance claims

  • Protecting cyber attacks

  • Offering digital encryption and security layers

  • Identifying suspicious activity

  • Hefty payouts record maintenance

  • Real-time healthcare checking

  • Predictive modeling

  • Database search

  • Data mining

  • Reporting tools

  • Visualization of fraudulent claims


Many health care providers face huge losses due to the rejection of claims and lack of patient engagement. Healthcare claims analytics can help in this too. Automation can redefine the statistics since the loss ratio represents the losses incurred in claims and expenses adjusted to the premiums earned, automation can help redefine the statistics. Both medical loss and commercial loss can be minimized as records are well-kept and eligibility for insurance claims is checked automatically in real-time. Some of the other ways automation can help here include


  • Calculation of losses incurred

  • Potential losses estimates

  • Loopholes in policies

  • Detection of claim rejection reasons

  • Custom medical claim analysis

  • Insurance analytics creation

  • Self-assessment protocols for patients

  • Premium estimation over costs


When collecting data to increase insurance policies, we cannot overlook the importance of telematics. Automation has simplified this aspect of insurance claims analytics as well, and it has refined the collection of information that providers can use to offer better policies to the patients. The rich data offered regularly can help decrease the insurance claim times in emergencies. Not only can this save millions of lives, but it can also help create authenticity for the provider. 


Concluding, it is important to note that automation does not cost much. Also, you don’t need extra space or infrastructure to accept automation in insurance claims analytics. It acts as an added part of the system that helps make things more accurate, robust, and dependable. If you are still thinking about whether to use it or not, this is the right time to give the nod to this tech-blessing. 

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