Dies ist eine Übersichtsseite mit Metadaten zu dieser wissenschaftlichen Arbeit. Der vollständige Artikel ist beim Verlag verfügbar.
AI and Human Collaboration in Claims Processing: Optimizing the Hybrid Approach for Healthcare Payers
0
Zitationen
1
Autoren
2025
Jahr
Abstract
AI is revolutionizing claims adjudication while maintaining essential human oversight in healthcare payment systems. This article examines the symbiotic relationship between advanced AI technologies and human expertise in modern claims processing. By exploring implementations at leading insurers like AmeriHealth, Cigna, and Blue Cross, we demonstrate how this collaborative approach enhances accuracy, prevents fraud, and ensures regulatory compliance. The integration of machine learning for pattern recognition, natural language processing for documentation review, and human judgment for complex determinations creates a robust framework that balances efficiency with quality care. Healthcare payers seeking to optimize their claims operations will discover actionable strategies for implementing hybrid systems that leverage the strengths of both artificial intelligence and human specialists while navigating the evolving regulatory landscape.
Ähnliche Arbeiten
Explainable Artificial Intelligence (XAI): Concepts, taxonomies, opportunities and challenges toward responsible AI
2019 · 8.200 Zit.
Stop explaining black box machine learning models for high stakes decisions and use interpretable models instead
2019 · 8.051 Zit.
High-performance medicine: the convergence of human and artificial intelligence
2018 · 7.416 Zit.
Proceedings of the 19th International Joint Conference on Artificial Intelligence
2005 · 5.776 Zit.
Peeking Inside the Black-Box: A Survey on Explainable Artificial Intelligence (XAI)
2018 · 5.410 Zit.