Page 67 - IMDR Journal 2025

Research Article
means less stress for everyone involved, from insurance LITERATURE REVIEW
staff to the person waiting for their claim to be approved.
Empirical Studies
Applicability in the Indian Health Insurance Industry
Review of AI Adoption in Indian Health Insurance
Adoption of AI in Indian Health Insurance
The integration of AI in health insurance claims processing
The Indian health insurance sector is undergoing a rapid has been a subject of growing interest among researchers,
digital transformation, driven by the increasing adoption of particularly in the context of emerging markets like India.
AI technologies. With a growing tech-savvy population and Several empirical studies have explored the adoption of AI
the rise of digital platforms, Indian insurers are leveraging in the Indian health insurance sector, focusing on its impact
AI to enhance efficiency, reduce costs, and improve on efficiency, fraud detection, and customer satisfaction.
customer satisfaction. AI-driven systems are being used to Below is a review of 5-8 key studies that provide insights
automate claims processing, detect fraud, and provide into AI adoption in Indian health insurance.
personalized customer experiences. For instance, AI-
powered chatbots are being deployed to handle customer Study 1 AI Adoption in Indian Health Insurance
queries, while machine learning algorithms are being used (Sharma & Gupta, 2021)
to assess risk and predict claim outcomes. This study examined the adoption of AI by Indian health
insurers, focusing on the use of machine learning algorithms
One of the key drivers of AI adoption in India is the need to
for fraud detection. The researchers analyzed over 10,000
address the challenges of a large and diverse population. health insurance claims and found that AI-based systems
India’s health insurance market is characterized by a high identified fraudulent claims with an accuracy of 92%,
volume of claims, varying levels of digital literacy, and a compared to 65% for traditional methods. The study
wide range of medical treatments. Handling insurance highlighted the potential of AI to reduce financial losses due
claims isn’t easy. It takes a lot of time, effort, and paperwork. to fraud, particularly in a high-volume market like India.
Many times, customers have to wait days — even weeks —
to get their claims processed. But now, smart tools are However, the authors also noted challenges such as the high
helping make this faster and easier. cost of implementing AI systems and the need for
continuous training of algorithms.
Let’s look at what some insurance companies in India are
Study 2 Comparative Analysis of Traditional vs. AI-
doing. ICICI Lombard has come up with a helpful mobile Driven Claims Processing (Patel & Singh, 2022)
app called Insta Spect. If someone’s car is damaged, they can
just take a photo and upload it. The app looks at the photo This study compared traditional claims processing methods
and gives a quick estimate no need to visit the office or wait with AI-driven systems in the Indian health insurance sector.
for a surveyor. The researchers found that AI-based systems reduced claim
processing time by 70%, from an average of 10-15 days to 2-
While this tool is used for car insurance, the same idea can
work for health insurance too. Instead of car photos, the 3 days. Additionally, AI systems improved accuracy by
system could look at medical scans or reports. It could help minimizing human errors, particularly in the analysis of
medical records and diagnostic reports. However, the study
check if a treatment was really needed — and speed up the
also identified concerns about the "black-box" nature of AI
claim process.
algorithms, with some customers expressing dissatisfaction
HDFC ERGO over the lack of transparency in decision-making.
HDFC ERGO is also using smart technology to help Study 3 Consumer Trust in AI-Driven Claims Processing
customers. They’ve set up chatbots that can answer (Kumar & Rao, 2023)
questions, help people file claims, and even check their
This study explored consumer perceptions of AI-driven
documents. This means customers don’t have to wait on claims processing in the Indian health insurance sector. The
hold or visit a branch.
researchers conducted a survey of 500 policyholders and
They’ve also built systems that learn from past fraud cases. found that 65% of respondents appreciated the faster
If something seems suspicious in a new claim, the system processing times offered by AI systems. However, only 45%
can catch it early. This helps stop fraud and saves money. expressed trust in AI-driven decisions, citing concerns about
Why This Matters fairness and transparency. The study emphasized the need
for insurers to improve communication and build trust with
These examples show how insurance companies in India are
finding new ways to work faster and better. Claims get customers, particularly in a market where digital literacy
settled sooner, staff have more time to focus on serious varies widely.
cases, and customers get quicker answers. Study 4 AI for Fraud Detection in Health Insurance
(Mehta et al., 2021)
But there are still things to think about. These tools work
with personal data, so privacy is important. People also want This study focused on the use of AI for fraud detection in
to know how decisions are made, and they want to be sure Indian health insurance. The researchers analyzed over
the system is fair. 15,000 claims and found that AI-based systems were able to
detect fraudulent claims with an accuracy of 90%, compared
As more insurance work goes digital, these smart tools will
become part of everyday life making things smoother for to 60% for traditional methods. The study highlighted the
both the companies and the people they serve. importance of anomaly detection techniques in identifying

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