Health insurance and technology leaders are optimistic that Artificial Intelligence (AI) and real-time data will enhance healthcare quality, reduce costs, and expand insurance access in Kenya. These advancements are expected to improve decision-making, streamline operations, and make health insurance more accessible to the population.
At the Digital Pulse CEO Roundtable 2025, hosted by M-TIBA, industry leaders from health insurance, reinsurance, technology, and healthcare sectors explored practical AI-driven strategies to transform healthcare and insurance. The event, themed “Connected Intelligence: The Future of Data, Tech, and AI in Health Insurance,” focused on how AI and real-time data can simplify health insurance processes and foster more efficient healthcare management.
“AI is the buzzword of the day. At this year’s event, we focused on turning innovation into real tangible benefits for health insurance,” said Pieter Prickaerts, CEO of CarePay International and M-TIBA. “Already, AI is proving most valuable in administrative tasks like approvals and claims processing, but more benefits of data and AI are expected in the near future.”
Early AI applications in health insurance—such as automated pre-authorizations and claims processing—have significantly improved efficiency. M-TIBA’s data-driven platform has shortened payment cycles by up to 95percent, while healthcare costs have dropped by as much as 15percent, allowing members to maximize their coverage. Additionally, members can track claims in real time, enhancing transparency and flexibility in decision-making.
Jubilee Health Insurance CEO Njeri Jomo highlighted AI’s role in optimizing pricing, enabling premiums as low as KES 500 per month. “AI has streamlined our administrative processes, allowing 80percent of claims to be processed faster while maintaining accuracy, efficiency, and predictability,” she said.
Furthermore, AI is improving real-time monitoring for healthcare providers, preventing duplicate treatments, detecting anomalies, and flagging high utilization. These advancements foster better collaboration between providers and insurers, leading to improved patient outcomes and cost savings.
Looking ahead, experts predict AI will play an even greater role in diagnostics, treatment recommendations, and drug development. However, they emphasize that human oversight will remain essential to ensure AI-driven decisions align with ethical and medical standards.
“AI is transforming healthcare much like electricity revolutionized industries,” said Dharmendra Jain, CEO of Actnable AI. “To unlock its potential today, we must take immediate, actionable steps, such as mapping the member’s health insurance journey to identify areas where AI can enhance the patient and member experience.”
Ezekiel Macharia, Managing Director of Kenbright, underscored the need for a pragmatic approach. “AI is strong in areas like reading, summarizing, and education, but when it comes to complex mathematics and data calculations, even the latest models are still struggling. In health insurance, we should focus on where AI truly excels, implementing it for tasks that can streamline administrative processes and improve efficiency,” he said.
“The industry must not expect AI to solve everything overnight. Instead, we should start with proven, high-impact use cases,” he added.
As AI continues to evolve, it is expected to assist in diagnosis, treatment planning, and even surgery. By reducing time spent on administrative tasks, healthcare professionals can focus on patient care and support more individuals.
