Introducing The Rapid Health Insurance Claim Process in a Short Span
Revolutionizing Health Insurance Claims Processing: AdvanceCare and Sprout.ai Lead the Way
In the rapidly evolving world of health insurance, two pioneering companies, AdvanceCare and Sprout.ai, are making significant strides in leveraging artificial intelligence (AI) to streamline and improve the claims processing system.
The pandemic has led to a surge in policyholder contact time for health insurers, with an average increase of 55%. However, complex systems have caused some potential fraud to be disregarded. Recognizing this, AdvanceCare and Sprout.ai have collaborated to address these challenges head-on.
AdvanceCare, a health insurer with 1.7 million members in Portugal, has witnessed remarkable improvements. The collaboration with Sprout.ai has led to an over 10% increase in automation levels in AdvanceCare's claims process. In fact, some health insurance claims are now being processed in as little as 60 seconds, thanks to the strategic rollout of Sprout.ai's AI technology.
Sprout.ai's platform combines advanced artificial intelligence with patented optical character recognition (OCR) technology to instantly extract, structure, and analyze information from claims invoices. This allows for faster, more accurate claim outcomes for a significant portion of the population.
The AI solution developed by Sprout.ai uses Natural Language Processing (NLP) and Knowledge Graphs for automated policy checking. This innovative technology enables context-aware decisions, interacting conversationally with human agents, and performing tasks like damage assessments or policy verification.
Liliana Silva, Operations Director at AdvanceCare, has praised the digital reimbursement solution provided through their app and web portal, stating that it is highly valued by customers. The focus on efficiency means focusing on time resolution and the quality of service provided.
Roi Amir, CEO of Sprout.ai, emphasizes that the collaboration proves that AI not only improves efficiency but also enhances the customer experience at scale. Sprout.ai has launched a transformational claim settlement solution for health insurers globally, utilizing Contextual AI.
The evolving AI capabilities include natural language understanding for interpreting unstructured clinical notes, intelligent document processing, real-time behavioral analysis to detect fraud, and agentic AI systems capable of multistep reasoning to manage complex claims workflows efficiently.
These advancements represent the shift from manual, rule-based insurance claim management to intelligent, automated systems that improve operational efficiency, customer experience, and cost savings for insurers and providers alike. Healthcare leaders are reporting that the time it takes for claims reimbursement is increasing, with 62% recognizing this as a growing challenge.
In summary, AdvanceCare and Sprout.ai exemplify the forefront of 2025 AI-driven health insurance claims processing by integrating cutting-edge AI tools to speed claims handling, ensure accuracy, reduce fraud, and enhance decision-making through intelligent, automated workflows.
- The collaboration between AdvanceCare and Sprout.ai, both leaders in insurtech, is promoting innovation in health-and-wellness and technology by introducing artificial intelligence to streamline the claims processing system, aiming to improve operational efficiency.
- The events in the health insurance sector have necessitated a need for improved technology, and the partnership between AdvanceCare and Sprout.ai showcases the use of science, such as Natural Language Processing and Knowledge Graphs, to automate policy checking and claims processing, ensuring faster and more accurate claim outcomes.
- With the launch of Sprout.ai's transformational claim settlement solution, events in the health insurance industry are witnessing a revolution due to the application of AI and advanced technologies like optical character recognition, natural language understanding, intelligent document processing, real-time behavioral analysis, and agentic AI systems, leading to enhanced customer experience, reduced fraud, and improved cost savings.
