AI is rapidly gaining traction in the health insurance industry. But according to one health insurance executive, AI shouldn’t be used for the “sake of AI,” but to empower what the health insurer is trying to accomplish.
During an interview at AHIP 2026 last week, Elevance Health Chief Digital Information Officer Ratnakar Lavu shared the company’s three key priorities for AI.
1. Simplifying and personalizing the member experience: Elevance is leveraging AI to make it easier for members to navigate their care. Lavu gave the example of a member with a knee surgery, who wants to know whether their benefits will cover the procedure, how much they will have to pay and which provider is best for that procedure. He noted that connecting these dots is typically very difficult for the member, so Elevance built a “ChatGPT-like experience” called Sydney on its app to answer these questions.
“A member can ask a question and say, ‘I have a knee surgery, do my benefits actually cover that knee surgery or not?’ … It understands who you are, it understands your benefits, it understands what you’re asking for, and then provides the right insight: ‘Yes, it is covered. This is how much you’ll pay. And then, by the way, there’s a provider who’s nearby who actually can provide quality care.’ Because we also have enough information about which providers are providing quality care for our members and at what cost,” Lavu said.
2. Simplifying the provider experience: Elevance is using AI to reduce the administrative burden on providers, such as speeding up prior authorization approvals, Lavu said.
“We don’t use AI for denials, so anytime the AI cannot result in an approval, it actually routes it to a human,” he said. “There’s always a human in the loop on this. But then we really want to get the approvals going fast, so that the provider can actually focus on the care for the member.”
3. Making sure employees have the right information at the right time: AI is also supporting Elevance’s employees to ensure they can effectively help members, such as through the call center, according to Lavu.
“We’ve done a lot of work in the call center,” he said. “When a member calls in, we understand who the member is. We aggregate all the information, administrative and clinical, and then provide it to the associates, so they can actually quickly resolve the member issues. And a lot of intelligence goes into that with AI. It is not just summarization, but it has enough insights about the member and their longitudinal journey with us.”
Lavu added that after member calls, Elevance also analyzes call summaries to determine member satisfaction and proactively reaches out to them if needed.
Photo: Sakchai Vongsasiripat, Getty Images
