Insurance / Health insurance
Aetna: AI agent support for processing complex medical claims that need manual review (Claims Assist Manager)
- Company
- Aetna
- Country
- United States
- Adoption stage
- In operation
- Source published
- Date basis
- The date the source was published. It can differ from the date adoption started.
- How the source was checked
- Read the full source text
The work problem
According to an announcement Aetna made on May 26, 2026, insurance claims processing is a major cost driver in the U.S. healthcare system, and the 2023 CAQH Index, an industry benchmark, estimates that providers and health insurers spend about 80 billion dollars a year managing administrative transactions. In Aetna's recent provider survey, reducing administrative burden and simplifying insurance processes also ranked among the highest priorities.
Technology and data
On the same day Aetna launched the second generation of Claims Assist Manager (CAM), its AI-powered claims advisor platform. CAM brings together eligibility, coverage, member and provider data, and adjuster AI agents automate resolutions or recommend next-best actions for claims. It targets complex claims that require manual review, and the platform is part of a 20 billion dollar multi-year investment in digital innovation that CVS Health is making to simplify the U.S. health system.
Results
Aetna said CAM's adjuster AI agents reduce processing time by more than 20% for complex claims that require manual review, helping providers get paid faster and more consistently. Katerina Guerraz, Aetna's chief operating officer, said that by reducing manual steps and accelerating decision making, Aetna delivers faster and more reliable outcomes for providers and members.
Limits and open questions
The announcement does not give the period or number of claims behind the reduction in processing time, or the change in payment accuracy.
Sources
- Aetna reduces claims processing time by more than 20% with AI to improve care experiencecvshealth.com, Accessed
Compiled from public sources. These are not results from ATF Works customers.