Large insurance carriers have been leveraging artificial intelligence (AI) across their operations for years. From automating claims intake and adjudication to detecting fraud and enhancing customer service, AI technologies such as Natural Language Processing (NLP), robotic process automation (RPA), and predictive analytics have become deeply integrated into their systems.

If you've ever been involved in healthcare billing, you know this much is true: claim denials are brutal. They're a drain on time, staff, and revenue. We're talking billions of dollars lost every year—not because the care was bad, but because of small administrative failures.

There was an old song from the 60’s by Joni Miller called “I’ve looked at Love from Both Sides Now.” Like Miller, and as a former Hospital Administrator and VP of Provider Network for major insurers, I’ve seen claims denials from both sides now as well. During my time as a provider, I have been in multiple situations where claims my team submitted were not paid despite our best efforts.

Every day, healthcare organizations generate mountains of data—doctor’s notes, discharge summaries, pathology reports, and more. And the vast majority of it is unstructured, meaning it doesn’t fit neatly into rows and columns in a database. It’s just words—written by humans, for humans.

Recent tragic events serve as a stark reminder of the immense pressure and stress surrounding the healthcare industry. This pressure extends beyond executives; it impacts patients, providers, and the entire healthcare ecosystem.