HEALTHTECH — HEALTH INSURANCE & CLAIMS

AI-optimized claims processing

Claims processing: 45-60 days → AI-optimized: 7-14 days. Automate adjudication, slash denial rates, and reduce cost per claim by 40%+.

45 → 7-14
Days processing time
75%
Denial reduction achievable
30%
Cost reduction via AI/RPA
AI-powered claims processing dashboard

Performance benchmarks

Where does your claims operation sit? Compare across four critical metrics.

Metric Industry Average Top Quartile AI-Transformed
Processing Timeline 45-60 days 30 days 7-14 days
Denial Rate 12-18% 8-10% 5-8%
First-Pass Approval 75-80% 85-88% 90-95%
Cost per Claim $4-6 $3-4 $2.50-3.50

Sources: Industry benchmarks 2024. Average denial cost: $15-30 per claim. ERISA compliance: urgent claims 72 hrs, pre-service 15 days, post-service 30 days.

What global leaders are doing

Industry examples from publicly reported initiatives — not Xamun projects. Included to illustrate what AI transformation looks like in this sector.

Leading insurers are transforming claims with AI and RPA at massive scale.

CVS Aetna
$20B Digital Transformation
  • Gen AI embedded end-to-end
  • Prior auth bundling: pharmacy + medical (industry-first)
  • 90 min saved per nurse per day
  • 4 systems → 1 unified platform
UnitedHealth Group
RPA + AI at Scale
  • Extensive RPA in claims processing
  • AI eligibility verification in real-time
  • 150+ million claims processed annually
  • Automated coverage checks
Industry RPA/AI Standard
End-to-End Claims Automation
  • AI reads unstructured forms → structured data
  • RPA bots verify coverage in real-time
  • AI monitors status, handles exceptions
  • Analytics adapts logic to reduce denials

The transformation opportunity

What changes when a mid-market insurer deploys AI across claims processing.

⚠ Before — Mid-Market Baseline
  • Processing time: 45-60 days average
  • First-pass approval: 75-80%
  • Denial rate: 12-18%
  • Manual review: 85%+ of claims
  • Cost per claim: $4-6
  • Claims errors: 5-8%
  • Customer inquiries: 100+ calls/day
✔ After — AI-Enhanced Processing
  • Processing time: 7-14 days average
  • First-pass approval: 90-95%
  • Denial rate: 5-8%
  • Manual review: 15-20% (exceptions only)
  • Cost per claim: $2.50-3.50 (40%+ reduction)
  • Claims errors: <1%
  • Customer inquiries: 20-30 calls/day (70%+ drop)
$5-10M annual savings for mid-size insurer (100,000-500,000 members)

How Xamun delivers this

From diagnostic to deployed system in weeks — not months.

1. XI Identifies
Claims Processing Gaps

Xamun Intelligence benchmarks your processing timelines, denial rates, first-pass approvals, and cost per claim against AI-optimized leaders. Identifies highest-value automation targets.

2. Software Factory Builds
AI Claims Systems

RPA for rule-based processing, NLP document understanding, real-time eligibility AI, denial prediction models, prior auth automation, and fraud detection — built in weeks.

3. Measurable Outcomes
3-9 Month Timeline

50-70% faster processing in 3 months. 10-15% first-pass improvement in 6 months. 40-50% denial reduction in 6 months. 70-80% fewer customer inquiries in 3 months.

See XI run a diagnostic on your claims operations

Book a discovery call to see how your claims processing benchmarks against AI-optimized leaders — and what Xamun can build for you in weeks.

Book a Discovery → Explore the Live Demo →