Unlock Operational Excellence: How AI is Transforming Claims Administration

Discover six real-world AI use cases that help health plans streamline operations, cut costs, and deliver better outcomes—faster.

Inside, you'll uncover:

Six actionable AI use cases for claims operations

Measurable outcomes from real deployments

Strategies for preparing your systems for AI

Insights from HealthAxis leaders on scaling transformation

How to achieve compliance, speed and saving, all at once

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AI isn’t just modernizing claims—it’s reshaping how health plans compete and scale.

Claims administration can no longer rely on outdated, manual processes. This whitepaper—authored by HealthAxis leaders—outlines how forward-thinking health plans are using artificial intelligence (AI) to optimize operations, reduce administrative burdens, and improve stakeholder satisfaction.

Reduces manual workload by automating routine claim processing, allowing agents to focus on resolving more complex or high-touch inquiries.

Improve accuracy and speed through real-time validation and predictive models that prevent common errors and reduce rework.

Enhances member and provider satisfaction by enabling faster decisions and reducing wait times for escalated issues.

Optimizes resource allocation by using AI-driven insights to direct claims to the right teams—ensuring human expertise is used where it matters most.

Administrative costs consume nearly 20% of every premium dollar. Traditional systems weren’t built for today’s pace—or tomorrow’s expectations. Learn how to turn claims into a strategic advantage, with the power of AI.

Download Whitepaper

See What Our Clients Are Saying

Our experience with HealthAxis spans many years and has been very satisfying. HealthAxis and our dedicated team have consistently demonstrated professionalism, and they have continued to perform at a high level. Their ability to adapt to our needs as it relates to Part B administration has been more than flexible and accurate. HealthAxis has displayed an ability to learn our clients' plans and help to ensure compliance with the ever-changing Medicare landscape. I truly appreciate and value the relationship with HealthAxis.

TPA Client

Vice President & General Manager

The team at HealthAxis is extremely helpful and informative. Their knowledge base for ideas, problem solving, and delivery are done so with outstanding quality and readiness. HealthAxis recognizes our concerns and they address them clearly and concisely by demonstrating superb product and system knowledge which earns our trust in their abilities.

Sharon Abney

Chief Operating Officer
InsuranceTPA.com Administrators

Over the course of our 22-year relationship, HealthAxis has provided exceptional service and support to our team. We value the collaboration and knowledge that their team brings to the table to address our concerns timely and efficiently.

Jennifer Moore

Vice President of the Group Health Program
NTCA–The Rural Broadband Association

HealthAxis has consistently met the Medicare supplement processing needs of our organization since January 2014. We can rely on them to process timely, error-free results. They maintain open communications and are very responsive to our processing and/or programming needs. We have asked for many processing upgrades over the years, and we have never had a request be denied or not be completed within time constraints. Questions are given top priory and solutions to issues are presented without prompting. Consistency is paramount, with minimal changes to the staff that supports us over the years. Overall, the relationship has been one in which we can truly trust they will meet the needs of our organization and policyholders.

Kevin Roberts

Sr. Vice President of Insurance Operations
United Commercial Travelers of America

The HealthAxis platform is a user-friendly system that allows for a smooth communication between each application. This allows for multiple departments to handle member customer service in an efficient manner.

Freedom Health and Optimum HealthCare

Bridge the Gap: Enhancing Operational Excellence

AI in claims administration plays a pivotal role in eliminating processing backlogs, alleviating call center surges, and accelerating overall claims timelines.

Eliminate Claims Backlogs

By automating repetitive tasks like data validation, eligibility checks, and straightforward adjudications, AI reduces the volume of claims requiring manual review—freeing up teams to handle only the most complex cases.

Alleviate Call Center Surges

With AI handling routine claim status updates and documentation reviews, call centers experience fewer surges, and agents can dedicate their time to high-value interactions.

Improve Timelines

The result is a faster, more predictable claims process that improves service levels, strengthens stakeholder trust, and boosts overall operational resilience.

Download our whitepaper to learn how AI is transforming claims, from intake to adjudication.

Download Whitepaper

Everything You Need In One Partner

CAPS Technology

Experience the perfect blend of technological optimization and adjudication efficiency with our fully integrated solution, meticulously crafted to streamline benefits administration, healthcare claims processing, and overall health plan management.

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Comprehensive Services

Our services, encompassing consulting, staff augmentation, BPO, and BPaaS, are tailored to let you concentrate on your core objectives. We expertly manage and enhance your business processes, providing the skilled support and strategic guidance needed. This comprehensive approach allows you to allocate time and energy where it truly counts, ensuring operational excellence across all facets of your organization.

BPaaS/BPO

Consulting Services

Staff Augmentation