In this Everest Group research, we showcase the current state of payers’ claims management processes and the associated inefficiencies. To overcome these efficiencies, payers need to adopt a digitalization approach that allows them to build a digital layer over their existing claims management systems, rather than embracing a rip-and-replace approach, which is marred by limitations such as high costs, downtime, and data loss. Such a digital claims management model, characterized by Artificial Intelligence (AI) / Machine Learning (ML) tools and strong IT and business collaboration, will enable payers to accelerate the claims settlement cycle, improve accuracy, and drive cost savings.
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