Health insurance claims management

The purpose of this study was to explore the impact of technology on efficiency in the management of health insurance claims. The research and discussions were guided by the specific objectives of the study which are: the capacity of health insurance companies to adopt technology in claims management; resource benefits resulting from implementing technology in claims management; the adoption and implementation strategies of implementing technology in claims management. A thematic analysis approach was employed in analyzing the qualitative data obtained from the field through in-depth interviews between January 2017 and August 2023. A total of fifteen (15) participants were purposively selected from three (3) health insurance organizations in Delta state, Nigeria, using structured interview guide. Result revealed that adopting and implementing technology in the claims management process facilitates timely processing and reimbursement of claims by health insurance companies and reduction of administrative and medical cost. Organizational scope, knowledge and awareness of available
advanced technology for claims management as well as financial capacity of the health insurance organizations are key enablers for the adoption of technology for claims management. Participatory decision-making and regular training of staff were also key factors in the implementation of advanced technology in the claims management process. Among the recommendations from this study is the need for the National Health Insurance Act (NHIA) to take measures that will boost national adoption of technology in claim processing by health insurance companies in view of the numerous benefits