AI to Transform the Health Claims Payments Process Qorus-NTT DATA Innovation in Insurance Awards 2026

The project goal was to use AI to reduce 3rd party spending and improve claims data, to increase operational controls while improving operational efficiency. All processes were thoroughly reviewed to automate and improve them wherever possible, leveraging the capabilities of a custom-built Intelligent Decision Support System (IDSS). The Go-live strategy included a parallel phase: a phased roll out by expense type, allowing the business team to validate the results before the full go-live. The complexity of implementing a cross-functional project demanded tight collaboration and strong teamwork. Critical success factors: - One Team, One Vision - Addressing Dependencies and respecting the Project Plan & roadmap - Anticipating Strategic Decisions - Managing Transformation. The several limitations inherent to the Health Claims processes made this project a high-impact use-case to prove the potential of AI and Gen AI Models solution, leading to cost reduction in three main streams: Providers; Operations; Claims Leakage