Generative AI in Member Portals for Benefits Explanation and Claims Walkthroughs
DOI:
https://doi.org/10.63282/3050-9246.IJETCSIT-V5I1P106Keywords:
Generative AI, Member Portals, Benefits Explanation, Claims Walkthroughs, Snowflake, OpenAI, Medicaid, Dual Members, RAG-based Integration, Healthcare AIAbstract
This paper investigates the more revolutionary possibilities of integrating their generative AI into member portals, especially for clarifying their benefits & directing claims procedures for Medicaid and Dual members. AI offers a streamlined & more efficient way for members to clearly comprehend their plans & claims as healthcare benefits become more complicated. Using Snowflake's extensive data platform & OpenAI's advanced language models, this link addresses questions & guides members around the process with actual time, customized support. Improving this harmony depends on the RAG (Retrieve, Augment, Generate architecture. It lets the AI acquire relevant information, improve it with more insightful analysis, & provide members more consistent, practical responses. This method ensures a smooth & also interesting experience wherein AI not only gathers information from sources but also cleverly analyzes & clarifies it in an understandable manner. By combining Snowflake & OpenAI APIs with the RAG framework, Medicaid and Dual members have a simple tool for easily managing their benefits & claims process, therefore improving both the efficiency & also satisfaction of their healthcare experience
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