How Elevance Health Is — and Isn’t — Using AI

Artificial intelligence (AI) continues to transform numerous sectors, and healthcare insurance is no exception. Elevance Health, guided by Ratnakar Lavu, the chief digital information officer, has embarked on a journey to incorporate AI technologies into critical operational processes. This blog explores how Elevance Health utilizes AI to streamline healthcare approvals, claims processing, and member support while deliberately maintaining human intervention on denials.

AI in Approvals and Claims Processing
In the complex landscape of healthcare insurance, processing approvals and claims efficiently can significantly reduce operational costs and improve member satisfaction. Elevance Health leverages AI algorithms to automate and speed up these tasks. By analyzing patterns in data, AI systems help determine eligibility and validate claims, reducing manual workloads and shortening turnaround times.

Member Support Enhanced by AI
Another area where AI has found a foothold is in member support services. AI-driven chatbots and virtual assistants provide real-time assistance to members, answer common questions, and guide them through their benefits. This not only improves responsiveness but allows human representatives to focus on more complex issues.

Maintaining Human Oversight on Denials
Despite embracing automation, Elevance Health consciously keeps denials under human review. This cautious approach acknowledges the importance of accuracy and fairness when claims are denied. Human experts can assess nuanced cases where AI might misinterpret data, thereby preventing potential errors and ensuring ethical decision-making.

Balancing Innovation and Responsibility
Elevance Health’s approach highlights the balancing act many organizations face when integrating AI. They seek efficiency gains but recognize the need for human judgment in sensitive decisions. This hybrid model may set a precedent for how AI can coexist with human expertise in healthcare operations.

Future Perspectives
As AI technologies evolve and mature, Elevance Health’s experiences will provide valuable insights into best practices for implementation. The ongoing monitoring of AI’s impact on operational outcomes and member satisfaction will be crucial to refining these intelligent systems.

In summary, Elevance Health’s selective use of AI illustrates how healthcare payers are navigating the promise and challenges of artificial intelligence. By automating routine tasks and preserving human involvement where it counts, the company is crafting a pragmatic path towards smarter, more efficient healthcare administration.

Source: https://medcitynews.com/2026/02/elevance-health-payer-insurance-ai/