Implementing Machine Learning for Healthcare Payors

Health insurance is an integral part of a person’s well-being and financial security. Unlike countries such as the UK and Canada, the US does not have a concept of universal healthcare. The majority of US residents are covered by plans from their employers who contract with private health insurance companies. Others rely on public insurance such as Medicare and Medicaid. The rising cost of healthcare has made it almost impossible for anyone to survive without health insurance. No wonder that, by the end of 2020, over 297 million people in the US had coverage for health insurance, with the number trending higher every year.

Health insurance companies, also known as healthcare payors, are organizations that cover the healthcare costs incurred by subscribers to their plan, known as payees. The payees (patients) or providers submit a claim to the payor for the costs incurred, and the payor, after doing their due diligence, pays...