Star Health to Expand AI Use in Cashless Insurance Claims Processing
Star Health and Allied Insurance Company Limited, India’s largest standalone health insurer, is significantly expanding its use of artificial intelligence to streamline the settlement of cashless hospitalisation claims. The company expects that AI systems could handle more than half of such claims within the next two years.
AI to Speed Up Claims Management
At present, roughly 20% of the insurer’s claims are processed using AI-based tools that automate parts of the claims workflow. These systems help the company manage approvals and settlements more quickly while ensuring compliance with regulatory standards.
Artificial intelligence is already being used in key stages of the claims process, including pre-admission authorisation and post-discharge settlement. Automation allows the insurer to meet strict turnaround requirements set by regulators.
Under guidelines issued by the Insurance Regulatory and Development Authority of India, insurers are typically required to approve pre-admission cashless requests within one hour. Post-discharge claims must generally be cleared within three hours, making technological automation increasingly critical for timely processing.
Target to Automate Over Half of Claims
Cashless hospitalisation accounts for about 85% of the total claim value handled by Star Health. With such a high share of cashless transactions, the insurer plans to significantly increase the use of AI in claims settlement.
Over the next two years, the company aims to raise the share of AI-handled claims to more than 50%. However, automation will not fully replace human involvement. Complex cases, large claims, and potential fraud investigations will still be reviewed manually by experts.
Industry Initiatives to Improve Claims Ecosystem
The broader insurance industry is also working toward improving the claims settlement ecosystem. The General Insurance Council is collaborating with hospitals to develop a standardised treatment pricing framework. This initiative aims to improve transparency in medical billing and reduce disputes during claim processing.
As part of these efforts, insurers are planning to expand hospital networks by empanelling around 10,000 healthcare facilities across India.
Digital integration is also being strengthened through platforms such as the National Health Claims Exchange (NHCX) and the Ayushman Bharat Health Account (ABHA). These systems are designed to facilitate seamless data exchange between insurers, hospitals, and patients, ultimately speeding up claim approvals.
Conclusion
By expanding the use of artificial intelligence, Star Health aims to enhance operational efficiency and deliver faster claim settlements for policyholders. Combined with industry-wide initiatives to standardise hospital pricing and digitise healthcare data exchange, the increased adoption of AI could significantly transform the health insurance claims process in India.
Disclaimer
This article is based on publicly available information and official statements. The content is intended for informational purposes only. The publication does not independently verify third-party claims or geopolitical assertions mentioned in international developments.