Health insurers are moving fast on artificial intelligence. Major payers are now committing billions of dollars to AI-driven transformation. UnitedHealth Group plans to spend $1.5 billion on AI in 2026, while Elevance Health has committed $1 billion. Both companies, along with Centene, earned spots on Fortune’s list of top companies for AI adoption in 2025. These numbers signal a clear shift. AI is no longer a pilot project — it is a strategic priority.
Payers are deploying AI across member-facing services, internal operations, and clinical tools. Furthermore, they continue to weigh how human oversight fits alongside growing automation. Below are five key areas where insurers are directing their AI investments.
1. Member Navigation and Digital Experience
Virtual Assistants Go Mainstream
One of the most visible AI applications is the virtual assistant. Several major insurers — including UnitedHealthcare, Elevance Health, Aetna, and Cigna — have already launched AI-powered chatbots for members. By the end of 2026, more than 20 million UnitedHealthcare members will gain access to Avery, the company’s generative AI virtual assistant. Avery helps users navigate care options and resolve common inquiries faster.
Elevance’s virtual assistant has already reached 22 million commercial members. In addition, the company plans to expand it to Medicare beneficiaries. Meanwhile, Aetna announced it would roll out voice enablement for its own generative AI assistant in early 2026.
Provider Matching and Cost Transparency Tools
Cigna has taken its digital strategy further than chatbots. The insurer launched a proprietary provider-matching tool alongside its AI chatbot. Moreover, Cigna redesigned its real-time cost-tracking feature. This tool breaks down deductibles, out-of-pocket costs, and integrated bill payments clearly. A claims submission function allows members to upload bills, auto-fills relevant details, and tracks updates in real time. Members with employer-sponsored coverage can also access plan selection support to compare options.
2. Prior Authorization and Claims Processing
Prior authorization has long frustrated patients and providers alike. Now, AI is helping to change that. According to recent Deloitte research, 93% of health plan executives expect AI to reduce the burden of prior authorizations through automation.
Elevance has seen particularly strong results. During its latest earnings call, President and CEO Gail Boudreaux reported that the company’s Health OS platform — combined with other AI tools — cut prior authorizations by nearly 70%. Health OS, part of the Carelon division, unifies provider data, lab results, and pharmacy information into a single platform. This integration fills data gaps that often trigger unnecessary claim denials. More than 60,000 Elevance associates currently use this technology.
3. Internal Automation and Workflow Efficiency
Beyond member-facing tools, internal automation is another major focus. Last year, UnitedHealth Group directed 26 million customer calls using AI agents. Former CEO Andrew Witty projected that AI would handle more than half of all customer calls by 2026. That scale of automation has significant operational implications.
Similarly, Humana deepened its partnership with Google Cloud earlier this year. Together, they launched Agent Assist, an AI-enabled tool that accelerates care-support activities for personnel. It reduces time spent on repetitive tasks and helps staff focus on complex member needs.
Elevance employees also benefit from an internal AI toolkit called Spark. Spark helps teams automate manual tasks — including document analysis and contract processing. As a result, staff spend less time on administrative work and more time on high-value functions.
4. Clinical Decision-Making and Value-Based Care
AI Platforms Supporting Care Coordination
Clinical AI tools are helping payers and providers close care gaps. Optum’s Value Connect platform brings together clinical, operational, and financial data in one system. This unified view supports both payers and providers in value-based arrangements. The platform identifies which members may need intervention before health conditions worsen.
Results have been notable. Optum reported that customers saw 29% fewer emergency room visits, 28% fewer preventable hospital readmissions, and more than a 20% improvement in care gap closure. These are not marginal gains — they represent real improvements in population health management.
Elevance’s Health OS platform also targets interoperability gaps. By connecting data across care settings, it helps clinicians make better-informed decisions without delays.
5. Predictive Risk Modeling and Research Support
AI as a Care Management Tool
Industry group AHIP recently highlighted how payers are applying AI to predictive risk modeling. These models analyze member data to identify individuals at risk of high-cost medical events before they occur. Early identification allows care managers to intervene with targeted support.
Beyond risk prediction, insurers are also using AI for research support in care management programs. Consequently, care teams can allocate resources more efficiently and focus outreach on members who need it most. This approach marks a shift from reactive care management to proactive, data-driven intervention.
What This Means for the Industry
Insurers are no longer asking whether AI belongs in healthcare — they are asking how fast they can deploy it responsibly. Across member experience, claims processing, internal workflows, clinical tools, and predictive analytics, AI is reshaping how payers operate. However, questions around human oversight, accountability, and equity remain active conversations. As investments grow, so too does the pressure to demonstrate clear, measurable outcomes for members and the broader healthcare system.
