Blockchain and AI Integration for Secure Health Insurance Claims Management
Keywords:
Blockchain, Artificial Intelligence, Smart Contracts, Health Insurance, Claims Management, Fraud Detection, Decentralized SystemsAbstract
The health insurance industry has been very key in standing in as a source of financial support for those with medical bills. However, the current claims management processes represent a problem because of inefficiency and some of the processes are opaque with high risks of fraud; and this results in massive losses to insurers. As for these challenges, this paper aims to discuss the possibilities of using Blockchain Technology and AI for improving the processes of the health insurance claim management. The claims process is made efficient since the application of blockchain technology in managing data is decentralized and has a structure that cannot be altered. At the same time, AI integrated for its superior pattern recognition inventiveness can in the same way identify fraudulent claims instantly while promptly addressing the genuine claims. This research introduces the integration of these technologies as the research offers a use case for smart contracts in automation of claims approvals and settlements while using machine learning models to detect fraud. As a result of this integration, the proposed system seeks to improve trust, cut down administrative expenses, and hasten the claims process to the advantage of insurers and policyholders. Last, the necessity and possibility of using the proposed models for other health insurance scenarios, further research prospects, and the consideration of key regulatory issues and challenges in adopting the emerging technologies when applied to the health insurance context are examined.
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