Health insurers are no longer treating artificial intelligence as an experiment. Today, they are making multi-billion-dollar commitments that reshape how members access care, how claims are processed, and how clinical decisions get made. UnitedHealth Group and Elevance Health each disclosed major tech investments — $1.5 billion and $1 billion respectively — during recent earnings calls. Both companies, along with Centene, earned spots on Fortune’s list of top companies for AI adoption in 2025. The message is clear: payers are all in.
Member Navigation and Digital Experience
Virtual Assistants Lead the Charge
Several major insurers now offer AI-powered virtual assistants directly to members. UnitedHealthcare plans to give more than 20 million members access to its generative AI assistant, Avery, by the end of 2026. Elevance’s virtual assistant already serves 22 million commercial members, and the company aims to expand it to Medicare populations next. Aetna, meanwhile, plans to activate voice capabilities for its generative AI assistant in early 2026.
Cigna Goes Further With Proprietary Tools
Cigna takes a broader approach. Beyond a standard chatbot, the company launched a proprietary provider-matching tool and overhauled its real-time cost-tracking feature. Members can now view deductibles, track out-of-pocket costs, and manage integrated bill payments in one place. A new claim submission feature lets members upload bills, auto-fills relevant fields, and processes updates automatically. Additionally, those with employer-sponsored plans can access AI-driven guidance on plan selection, helping them understand expected costs and available providers before they enroll.
Prior Authorization and Claims Processing
Automation Cuts Wait Times
Prior authorization remains one of healthcare’s most frustrating bottlenecks. Insurers are using AI to fix that. A recent Deloitte study found that 93% of health plan executives expect AI to deliver meaningful value by automating prior authorization workflows. That shift is already underway.
Elevance Reports a 70% Reduction
Elevance CEO Gail Boudreaux reported during the company’s latest earnings call that its Health OS platform has cut prior authorizations by nearly 70%. Health OS unifies provider data, lab results, and pharmacy information — filling informational gaps that commonly trigger denials. More than 60,000 Elevance employees now use this platform. The tool does not just speed up approvals; it makes each decision better-informed from the start.
Internal Automation at Scale
UnitedHealth and Humana Scale Up Agent Tools
Internal automation sits at the core of most major payer AI strategies. Former UnitedHealth Group CEO Andrew Witty noted that AI agents directed 26 million customer service calls last year. The company expects AI to handle more than half of all customer calls by 2026. Separately, Humana partnered with Google Cloud to launch Agent Assist, a tool that accelerates support activities for care personnel and reduces manual handling time.
Elevance Employees Use AI Daily
Elevance equips its workforce with an internal AI toolkit called Spark. Staff use Spark to automate document analysis, contract processing, and other repetitive tasks. The result is faster turnaround and fewer manual errors across operations.
Clinical Decision-Making and Predictive Tools
Optum Integrates Data for Value-Based Care
Optum’s Value Connect platform brings together clinical, operational, and financial data for payers and providers engaged in value-based arrangements. The system flags members who may need care intervention before a crisis occurs. Customers using Value Connect reported 29% fewer emergency room visits, 28% fewer preventable hospital readmissions, and more than a 20% improvement in care gap closure — all within a single year.
Predictive Risk Modeling Gains Ground
Industry group AHIP has highlighted how payers now apply AI to predictive risk modeling and research support. These tools assist care management teams in identifying high-risk populations earlier and directing resources more efficiently. Elevance’s Health OS similarly targets interoperability gaps that often delay or prevent timely care coordination.
What This Means for the Industry
AI adoption among health insurers is accelerating on every front — from the member’s first chatbot interaction to complex clinical decisions in value-based care. The investments are substantial, but early results suggest real returns: fewer denials, fewer ER visits, and millions of members navigating care with greater ease. As insurers refine how humans stay “in the loop” alongside these systems, the next phase of AI-driven healthcare is already taking shape.
