Health Insurance Claims Automation & ID Verification

Howard Schulman

Health insurance claims automation can bring a myriad of benefits to an organization. The business will be more efficient because of the cost savings from automation. In addition, customers get to enjoy a superior experience from the system. Despite these benefits, automation can increase the likelihood of fraud if risks are not properly addressed. Fraudsters can take advantage of technology to breach the system. Studies show that non-health insurance fraud costs businesses at least $40 billion yearly. But businesses can incorporate identity verification technology to ensure automated processes are protected from fraudsters.

Health Insurance Claims Automation

Health insurance organizations are shifting their attention to improving the customer experience. They are doing this through leveraging technology especially AI. Automating claims in health insurance involves using programs or robots to process claims with minimal input from humans.

The process of filing for a claim is not as simple as it sounds. Insurance adjusters are responsible for handling these claims. The adjusters determine the viability of the claim and the compensation that the victim gets. In the past, this system was very efficient. But nowadays, insurance companies can receive thousands of claims per day.

An automated system can analyze these claims at a faster rate than the insurance adjusters. Additionally, the system can tell if a claim is fraudulent or authentic. Automating health insurance claims enables insurance firms to conduct sophisticated processes. Automation can perform complicated processes such as risk identification faster and more accurately.

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The Role of ID Verification in Claims Automation

Identity verification is a crucial step in any system. It ensures that a person’s identity matches who they claim to be. The ID verification process relies on a person’s unique set of traits and characteristics that are irreplaceable to identify them accurately. In most institutions, the ID verification process is part of wider KYC procedures and protects businesses from fraudsters.

In the online sphere, there are various ways of conducting identity verification. The common method is the use of images and selfies. There is also the option of streaming-video identity verification. Photos and selfies are more appropriate for low-risk operations. When sharing sensitive information such as health records, video-streaming identification is more reliable. This identification makes use of machine learning and AI to optimize the identification process.

Below is a short-description of the Identity verification process:

  • The user visits the website or ID verification application of the organization
  • The application will prompt the user to allow it to use the gadget’s microphone and camera to verify their identity
  • The application will then ask the user to display their government-issued ID on both sides. In case the user does not have their ID, they can choose to display their passports or driver’s license
  • The user will then need to show their face at the camera. At this point, the system will be able to identify you based on your photo and the details from your ID. If your details check-out, the system will allow you to proceed
  • For highly-sensitive or valuable process, a separate team may qualified agents may need to confirm the selfie or video again

How ID Verification Can Help Support Health Insurance Claims Automation

The claims process is crucial for the profitability of any insurance firm. Once insurance firms attract a new customer, their next goal is to retain the customer and minimize unnecessary expenses. They also aim at delivering a strong and friendly claim process. Insurance firms have automated their systems to achieve a seamless and efficient system of handling claims.
Automation increases the likelihood of the business being a target for hackers and fraudsters. The activities of fraudsters affect both the insurer and the insured. Insurers suffer from the negative publicity that fraud cases bring to a firm. The insured will suffer because the fraudster will use their identity to steal claims that belong to them.

The ID verification process can detect spoofs and deep fakes in an automated claims process. The verification process is instant. It only requires people to upload their photos and documents for authentication. As a result, legitimate customers get to move on to the next stage of processing the claims in a short period. This is unlike traditional processes. These processes required people to go for in-person meetings. This prolongs the claim process and frustrates legitimate claimants.

Some of the benefits the organizations can derive from using ID verification in the automated claims system include:

  • Compliance: ID verification helps the organization to meet regulations requirements. For instance, GDPR requires that insurance firms assure customers that their personal information is safe. The identity verification allows insurance firms to identify exactly who they are paying the claims to
  • Building Customer Loyalty: The identity verification process in an automated system is quite fast and hence reliable for most customers. Aside from the speed, customers have a certain degree of assurance that unauthorized people cannot make claims on their behalf. This has a positive effect on the customer’s morale and loyalty.
  • Reducing Costs: Insurance fraud is costly for insurance companies because they lose money which they will have to compensate from their own pockets. There is also the possibility that a customer can sue for negligence when people make claims using their information. This only adds to the cost as the court may impose a fine. Instant ID verification keeps out fraudsters who are the source of these troubles.

Way Forward

Automating health insurance claims will benefit the insurance firm. But for these firms to enjoy the benefits of automation, they have to mitigate the risks that these systems pose. Fraud is a great concern for most organizations that automate their claims process. Incorporating identity verification in these systems can reduce the cases of fraud.

The verification will also provide customers with some degree of assurance that their data is secure. With more insurance firms understanding the value of customer experience, the ID verification process is now a key priority. For insurers looking to get real value from building fraud-proof digital systems, identity verification is the answer. Visit for your ID verification solutions and more.

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