Another generative AI tool expected to launch later this year in the UnitedHealthcare and Optum subsidiary apps is a consumer-facing conversational bot that will help customers find a doctor, schedule appointments, or review their lab results. That tool was initially tested with UnitedHealth’s employees before it will debut externally.
“It’s a maze,” says Dadlani, of the labyrinth that customers face when dealing with health care providers, insurers, and laboratory services. “So something that helps navigate through that and provides great end-to-end access, that’s the dream.”
Dadlani says around 90% of claims are auto adjudicated, the process in which software is able to manually review a claim. Of the 10% of claims that go through an extra step for review, most of the issues are clerical, meaning there are missing details or the information wasn’t input into the system properly. After that manual review, Dadlani says 98% of claims are approved and for the remaining 2%, denials tend to be attributed to either ineligible benefits or because of clinical or medical safety determinations.
Later this year, Dadlani says he intends to launch new AI products that will make auto approval for claims even higher. “We are already seeing in our early experimentation that AI can help fill some of the missing information for these claims,” he says.
UnitedHealth’s vast AI portfolio is reviewed on a monthly basis by every business unit. On a quarterly basis, chief information officers come together to monitor how AI is being used across the enterprise. The company has also established a responsible AI board that is a mix of internal and external technologists, clinicians, legal experts, and others who review hundreds of AI use cases each month before authorizing what can go into production.
Dadlani says UnitedHealth monitors AI use cases for safety, bias, fairness, and legal compliance. He stresses that AI is not being used to perform a clinical diagnosis. “We don’t see AI replacing doctors or clinicians,” he says. “We want AI to be a tool.”
To bring the workforce along, UnitedHealth launched an advanced AI learning course in early March that saw more than 10,000 enrollees. The company has also set up a dedicated platform, called United AI Studio, that allows employees to securely access the large language models offered by large AI hyperscalers, as well as the small language models that UnitedHealth developed on its own based on proprietary datasets.
The company also had about half-a-dozen use cases in production based on agentic AI, which is designed to more autonomously complete complex tasks—ideally with limited or no human supervision. Most of the agentic AI use cases have been for repetitive, administrative tasks. The technology will need to mature more before it expands to other parts of the business.
“We will be very cautious when we get into more clinical use cases and the use of agents,” says Dadlani.
John Kell
