With the ongoing advancements in Artificial Intelligence technology, there is a notable influence on the range of services offered at health insurance establishments.
With the help of AI-driven algorithms and systems, these establishments are capable of managing vast quantities of information and simplifying workflows effectively.
This leads to quicker and more precise service for clients.
AI is also improving the total customer experience through personalized suggestions and forecasts derived from personal health information.
This approach aids insurance firms in customizing their products to meet individual client requirements, while simultaneously enhancing risk assessment and facilitating more economical choices.
By incorporating artificial intelligence, healthcare providers can offer superior services to their clients, resulting in higher customer contentment and significantly better health results.
At Jubilee Health Insurance, incorporating AI hasn’t just proved beneficial; it has also enhanced efficiency for their clients.
To grasp the influence of AI on the insurance sector, the Star had a conversation with Njeri Jomo, the CEO and Principal Officer at Jubilee Health Insurance.
Jomo mentioned that the uptake of AI within Kenya’s insurance sector is still at an initial yet encouraging phase, characterized by extensive investigation into potential applications.
“AI in Kenya is still in the initial stages as they work towards identifying potential applications. While the sector shows promise regarding current usage, significant progress is anticipated over the next few years,” she stated.
Jomo stated that health insurance constitutes approximately 30 percent of the overall claim costs related to fraud, waste, and abuse.
As she explains, they are employing AI to detect issues at an early stage in order to avoid additional losses and boost efficiency.
She mentioned that health insurers employ machine learning technology, describing it as highly influential in their industry.
“We’re engaging in numerous discussions regarding the shift from curative to preventive healthcare. We aim to pinpoint customers who might be at higher risk of developing any number of chronic diseases. Understanding these trends could highlight concerns worth addressing. This is how we wish to assist our clients. Machine learning plays a significant role in this dialogue,” she stated.
As stated by the CEO of Jubilee, technological advancements and the implementation of AI enable their presence for clients even when they are hospitalized for different reasons.
Jomo mentioned that they use machine learning synonymously with chatbots for customer engagement.
Nevertheless, she mentioned that they employ AI judiciously to ensure they maintain a personal connection, as health insurance often requires interacting with an actual person.
“We get many paper invoices and documentations from service providers who haven’t embraced digital solutions. We aim to utilize these resources so we can extract necessary data and transform them into formats compatible with our system,” she explained.
Jomo mentioned that at Jubilee Insurance, they use artificial intelligence to expedite claim processing so customers can settle their payments with providers promptly.
She mentioned that regarding health insurance, the firm doesn’t directly reimburse clients; instead, they utilize a card to draw from credit facilities and subsequently settle accounts with the service provider.
At Jubilee, Jomo mentioned that payments to service providers could be made as quickly as 21 to 30 days, essentially equating to cash terms.
When talking about credit, we refer to periods longer than 90 days; however, we manage this for our clients effectively. We’ve observed significant positive interactions as a result. This allows customers to experience quicker processing times when settling payments with providers, enabling those providers to better cater to their needs. She highlighted this as a remarkable advantage.
In a May 23, 2025 interview with The Star conducted at her Nairobi office, Jubilee Health Insurance CEO Njeri Jomo shared insights during a conversation with Leah Mukangai.
Using AI, they can evaluate each individual claim all the way down to the smallest distinguishable unit.
The insurance company can determine the bank responsible for packing the medication. If they were an inpatient, they could also report the amount spent on the gloves.
All of these expenses ultimately appear as charges on the customer’s invoice. Consequently, during their policy renewals and in subsequent periods, this affects the overall cost of insurance. When customers face unusually high billing errors that do not belong to them, it leads to increased premium payments upon renewal, even though such hikes may be unwarranted.
We dedicate considerable effort to evaluating these claims, and the AI proves invaluable here as it can swiftly determine within mere milliseconds which cases warrant billing or not.
Jomo pointed out that although using AI has made their workload easier, it also comes with various challenges.
A challenge lies in dealing with limited data, as the information available is often disorganized. They must then tidy it up to obtain consistent data that provides meaningful insights.
“She further explained that many facets of dealing with data limitations involve assessing the quality of the data and spending considerable time refining extensive amounts of historical data to ensure it can be effectively utilized for its designated purpose.”
Jomo says that lack of regulation, talented personnel issues, and leveraging AI present additional hurdles for their insurance business.
She mentioned that they initially assess the decisions made by the system through a human perspective and concentrate on developing models designed to eliminate biases.
As we implement these models, we consistently ensure that we incorporate a human review process. This involves verifying numerous outputs through quality checks to confirm whether the results remain consistent and align with expectations.
She mentioned that AI systems must be trained using varied datasets to guarantee they produce balanced outcomes.
Jomo stated that AI offers an opportunity for customization, which will be crucial for enhancing efficiency as organizations develop.
“We’re seeing organizations aim to become more streamlined in order to deliver greater value. AI offers numerous chances for improving efficiency. There’s potential here as it brings together many valuable learning opportunities. Just think about the vast amount of knowledge we could accumulate using all these learning models,” she stated.
Health insurance emphasizes outcomes. It revolves around guaranteeing that you can examine a client’s health patterns, medical records, and compare them with those of a comparable group. You should be capable of noticing recurring issues for the client. By leveraging technology and artificial intelligence, we can develop more accurate predictive models to enhance our strategies in reaching the market.
Jomo mentioned that they develop their own AI in-house to enhance innovation and advancement, as well as collaborate with various external suppliers.
In most cases, if we can’t find what we need on the shelf, we’ll try to create it internally when possible, or look for opportunities to make adjustments.
However, she mentioned that they seldom use AI from external suppliers as they do now.
Jomo stated that AI, similar to other innovations, will necessitate certain guidelines to regulate its capabilities.
“There is a requirement for some guidelines. The regulator’s current strategy involves gaining insight into potential applications of these systems. Currently, they are collaborating with us to comprehend how these technologies will be utilized and the probable risks associated,” Jomo stated.
We anticipate observing regulations gradually shifting towards this approach over time. The innovation sector is currently in an initial phase within our industry, and we’re receiving substantial backing from regulators who wish to comprehend how we utilize these innovations. They ensure there’s no prejudice involved and that consumers aren’t adversely affected.
She wishes the change won’t hinder creativity, yet she realizes that certain regions might experience stricter, more meticulous oversight in some capacity.
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