"Healthcare payers create networks, define rules, set prices, and process payments-tasks that artificial intelligence (AI) can execute well, with the right direction. The conventional wisdom is that AI-driven automation can increase efficiency, while lowering administrative and medical costs. That is true enough, but like most conventional wisdom, it's also obvious. Let's go a little deeper: How can AI change howwork is done? And how can payers do more for their members?"
""Do-ers" are individual contributors who perform the necessary day-to-day tasks. "Deciders" are executives and managers who have the authority to set strategy, allocate resources, provide approvals, and ensure sound governance. The rest, about 10% to 15%, are "interpreters." People in these roles, including project coordinators and many middle managers above the direct supervisory layer, transmit information from the deciders to the doers or among the deciders. Agents could replace many of these interpreter roles; the same is true for the doers."
AI can execute payer functions such as creating networks, defining rules, setting prices, and processing payments when given proper direction. AI-driven automation can increase efficiency and lower administrative and medical costs. McKinsey estimates that 65% to 80% of payer jobs are transaction-oriented and could be fully automated. Another 10% to 25% are knowledge-oriented roles, while the remaining jobs, including sales, are relationship oriented. Generative AI can boost productivity in both knowledge and relationship work by up to 50% by handling lookups, data cleaning and collation, note-taking, and proposal drafting. Workforce roles include doers, deciders, and about 10% to 15% interpreters; agents could replace many interpreter and doer functions.
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