Anthem
AI Audit & Custom SaaSAnthem Uses AI to Halve Insurance Claim Processing Time
50%
Faster Processing
$10M+
Annual Savings
60%
Auto-Approval Rate
Challenge
Claims took weeks to review manually, driving up costs and delaying reimbursement.
Solution
Implemented an AI-driven claims audit and processing system to verify coverage and flag errors.
Results
50% faster claim approvals, tens of millions saved annually through efficiency and fraud prevention.
Full Description
Anthem (now Elevance Health) faced the industry-wide challenge of slow claims processing. Manual review of medical codes and policy adherence was inefficient and led to payment delays.
The company deployed a custom AI auditing system that uses machine learning to review claims against policy rules and historical data. The system can automatically approve standard claims and flag potential errors or fraud for human review. This hybrid approach significantly sped up the reimbursement cycle while maintaining strict compliance.