Revolutionizing medical insurance: The transformative impact of AI in the USA

The birth of Artificial Intelligence (AI) has ushered in a new era of transformation in USA medical insurance as it is being used to solve inefficiencies and improve the outcome across the sector. In this paper we examine the role of AI in redefining the landscape of early disease detection, personalized risk management, allocation of resources, and fraud detection. Machine learning (ML) and deep learning (DL) based AI technologies enable predictive maintenance (PdM) and allow for proactive interventions rooted in identification of complex data patterns. This is highlighted by case studies including Aetna’s implementation of AI to detect lung cancer and Optum’s risk stratification models. However, issues of data privacy, algorithm bias, and legal restraints present challenges which necessitate the creation of adequate frameworks that promote ethical and responsible application of AI. Human centered AI design (including explainable AI and engagement), integration of social determinants of health, and equitable and transparent solutions are the future research directions. This study establishes AI’s capability to transform medical insurance into a data driven, forward thinking, patient centric organization.