How AIA used Gen AI to solve an age-old pain point in medical insurance

By Claudio Caula - Director of Group Data Analytics and Artificial Intelligence.

Submitting and processing medical insurance claims requires time and effort from customers and insurers alike, involving manual paperwork, meticulous documentation, and expert review. AIA is harnessing the immense potential of Gen AI to reshape the way insurance is delivered and customers are served to become an even more customer-centric, efficient, and intelligent insurer.

Generative AI is poised to transform customer service within the financial industry, prompting organisations to rapidly develop and implement advanced technological solutions. We have enhanced our health claims operations through the adoption of Gen AI based OCR technologies and AI-driven auto-adjudication, resulting in improved customer experiences and greater operational efficiency at scale. These initiatives have led to increased auto-adjudication rates and expedited processing of minor claims, many of which are now completed within a single day.

Three-tiered AI solution

AIA has developed a three-tiered system of automation that creates STP benefits and increased efficiency, but more importantly, ease of use for our customers.

Firstly, customers can submit invoices by photographing documents, which our Gen AI-powered Image Workflow processes to extract key information, eliminating the need for physical forms.

The GenAI OCR solution, developed at AIA, outperforms standard options by recognising non-standard formats, supporting multiple languages, and even reading handwriting. It offers automated, instant validation with 97% accuracy, flags poor-quality images, and prompts customers to retake photos if necessary. This technology speeds up claims filing and has contributed to our top Net Promoter Score in Hong Kong for ease of use and customer satisfaction.

Secondly, we use Gen AI to significantly speed up the claim adjudication process. Each case requires reviewing multiple documents, such as laboratory results or scans, in various formats, which may be multilingual or handwritten, and include specialised medical terminology. We use Gen AI to summarise complex medical reports for the assessor, which cuts the time required for each review in half, and the same technology is also being applied to the underwriting process.

Thirdly, AIA has leveraged the power of AI to engineer a sophisticated fraud, waste, and abuse (FWA) detection system. More than 20 risk indicators have been created, from excessive lengths of stay to suspicious pre-existing conditions and suspected collusion, to proactively monitor and manage FWA risks. The risk thresholds of these indicators are adjusted based on an encoder-decoder anomaly detection model, flagging high-risk claims based on their FWA risk across all risk indicators.

This streamlined process provides customers with faster decisions and payments, improving the overall experience whilst mitigating FWA risks. In Korea, Gen AI has cut the claim process from two days or more to less than 25 minutes.

Currently rolled out in 4 main markets, this initiative has transformed operations and customer satisfaction. Digital adoption and process redesign drove end-to-end claims straight-through processing from 22% (June 2020) to 73% (December 2024), auto-adjudication from 41% to 75%, and e-payment adoption to 99%.

Leading AI innovation

AIA approaches Gen AI adoption powered by a strong culture of rapid in-house innovation, testing and implementation. We have recently completed an extensive, US$800m project to rebuild our technology, data and analytics platforms, which included moving more than 90% of our computing processes to the cloud. The cloud has enabled nimbler, cost-effective and rapid innovation across all departments of our company.

Our Gen AI journey has only just begun, and AIA teams across Asia are constantly developing and testing new Gen AI solutions to make healthcare and medical insurance more affordable, efficient for millions of people in Asia. This innovative spirit is helping people live Healthier, Longer, Better Lives.