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M-TIBA Adopts AI for Insurance Claims Processing

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By Monica MUEMA

M-TIBA, a leading health insurance technology platform, has integrated Artificial Intelligence (AI), into its insurance claims processing system, drastically reducing claim approval times to just hours.

The implementation of AI technology, and in particular Machine Learning (ML) models, enhances efficiency and fraud management resulting in lower administrative and healthcare costs for health insurers. This ultimately allows health insurers to offer more affordable health insurance products to their customers.

“The AI solution is seamlessly integrated into our claims assessment process.This new system enables us to expedite claims reviews significantly,” said Mr. Shadrack Kiratu, Head of Pricing and Portfolio Management.

“This innovative technology, developed and tested over the past three years, complements our existing systems, automating claim approvals without requiring manual review for each submission.”

Currently, over 40 percent of the claims can be automated. The AI technology swiftly approves claims upon submission, allowing claims assessors to concentrate on more complex evaluations.

Over the last three months, M-TIBA has employed advanced technology to automatically assess claims for leading health insurers, facilitating faster payments to providers and hence improving their cash flow.

“Previously, manual claim reviews prolonged the approval process as traditional technologies are not scalable. With AI technology we can automate claims assessment at a scale, enabling our insurance clients to grow faster and our team to focus on more complex claims requiring additional expertise.

With a more efficient system in place, insurers can pass on these benefits to their members in terms of more affordable health insurance products, making healthcare more accessible to a wider population,” added Mr. Kiratu.

According to the Insurance Industry Market Report 2022 by the Association of Kenya Insurers (AKI), the industry has witnessed an increase in claims frequency in recent years, which could become burdensome and expensive if insurers fail to embrace technologies such as Artificial Intelligence for claims processing.

This technology can be applied responsibly and in line with data protection and other regulations.

Regulations require insurers to admit or deny liability, determine amounts, identify claimants, and make payments within 90 days (about 3 months).

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