Long-standing issues such as healthcare costs and patient expectations are continuing to rise in the UAE. According to Sehteq-CloudKair Solutions’ Dr Saif Aljaibeji, more insurers are turning to AI for help.
Medical claims processing “is complex and often inefficient, involving multiple stakeholders,” said Sehteq-CloudKair Solutions co-founder Saif Aljaibeji.
As a result, with rising healthcare costs, growing patient expectations and increasing demand for operational efficiency, insurers in the UAE are turning to AI to solve long-standing problems in claims processing, Dr Aljaibeji said.
Using AI in medical claims processing
Challenges insurers in the UAE face in medical claims processing include data entry errors, delayed reimbursements to healthcare providers, the risk of duplicate claims or resubmission and fraudulent claims, according to Dr Aljaibeji.
He said, “These issues are resource intensive and slow down the claims cycle.”
AI offers solutions, such as automating routine tasks using logic, detecting anomalies in real-time and improving the accuracy of claims assessment, he said, resulting in “faster settlements, fewer errors and reduced operational costs”.
Several AI technologies may be used to streamline operations, improve accuracy and reduce fraud in medical claims processing, according to Dr Aljaibeji. These include:
- Machine learning (ML): Enhances decision-making, predicts outcomes, detects patterns and automates workflows. It is used in claims adjudication, fraud detection and predictive analytics.
- Robotic process automation: Automates repetitive tasks, freeing human resources for more strategic work.
- Chatbots and virtual assistants: Improve customer service by providing real-time claim status updates to both providers and patients. ChatGPT powered communication with patients suffering from chronic medical condition helps them better understand how to use the medicine and ask for a refill.
- Natural language processing: Codes claims directly from doctors’ notes. Dr Aljaibeji said this was more relevant in markets outside the UAE, as the country already has a structured data scheme for claims processing.
Dr Aljaibeji also highlighted some advantages AI can offer patients, such as using AI-powered chatbots to enhance the customer experience by providing quick updates on claim statuses and improving transparency.
Ensuring accuracy and reliability
“Accuracy starts with the quality of data,” said Dr Aljaibeji.
“We ensure AI models are trained on high-quality, diverse datasets, validated against benchmarks from our medical team’s experience in the UAE market and continuously tested for bias,” he said.
He noted that ongoing validation was crucial to maintain reliability and ensure that AI systems were making decisions that align with industry standards and regulations.
“The UAE’s population is highly diverse, so training AI systems requires access to comprehensive datasets that reflect this diversity. This includes claims data from hospitals, clinics and insurance providers across the country.
“By ensuring that these datasets capture a wide range of healthcare practices and cultural nuances, we make the AI system more robust and adaptable to local conditions,” he said.
Regulatory environment
The UAE “is highly supportive of AI innovation, with a forward-thinking regulatory environment”, Dr Aljaibeji said, referencing the UAE’s Artificial Intelligence Strategy 2031 and Personal Data Protection Law. He also said that the frameworks “[provided] clear guidelines for data privacy and AI adoption, ensuring AI is deployed responsibly”.
He said, “While specific regulations for AI in medical claims processing are still evolving, existing frameworks in the insurance industry already support the use of AI to drive efficiency and innovation.”
Implications and the future
While AI will undoubtedly automate routine tasks, “it will also create new job opportunities in areas like AI development, data science and ML,” according to Dr Aljaibeji.
He said, “As insurers integrate these technologies, the demand for skilled professionals will increase.”
At the same time, he believes that there will be a shift towards more strategic roles in customer service and claims management, where human oversight would remain essential.
“The challenge will be upskilling the workforce to work alongside AI systems to enhance the overall customer experience,” he said.
He also said that it was “worth noting that technologies like AI will likely disrupt the traditional business process outsourcing model”, as more tasks would be automated within the UAE.
“The impact of AI on medical claims processing is just beginning to unfold.
“In the UAE, where technological innovation is a top priority, insurers that embrace AI will gain significant competitive advantages,” he said.
Even as the shift to AI reshapes the workforce, Dr Aljaibeji also believes that it will open new avenues for growth and innovation and ensure that the UAE’s medical insurance sector remains at the forefront of digital transformation. M