I bet the corporation is going full on AI where UR and Care Coordination Nurses will be replaced. Instead of paying $70,000 + benefits to nurses. It is cheaper to use AI that work 24/7, no sick time, no PTO, no health benefits.
I can tell you l have seen AI approve claims and misread the clinical criteria that should have been denied. It will actually end up costing the corpration more money loss in the long run.
I see it on a daily basis.
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@k6 Oh on a certain level AI is already taking our jobs in ALL areas that are non membership facing - don't fool yourself. And the jobs they don't replace with automation will be replaced by contractors and H1Bs. This is the goal - SL has made that intention very public in her interviews online. "Back end operations with zero human intervention". No one said AI/automation was doing a good job or is better because from what I can see just about everything it touches turns to sh-t.
You think Centene IT can pull this off??? AI is not taking your jobs anytime soon at Centene. We cant even get the basic IT right.
I laugh. Most their other systems only work half the time and they want full on automation? Truly laughable.
@a6 but think of the margin gains…
I work in claims ops and AI routinely either pays or denies incorrectly. It can't read EOBs most of the time or NDCs for example. They rely too heavily on automation w/o listening to our feedback about the mistakes its making like we have no clue. We work the claims 8hrs a day 5days a week pretty sure some of us can connect the dots. We are told to "trust the system" and then get talked to because we have so many disputes that are aging. With the shrinking head count every 3mths we can't keep up with the disputes. Or they create projects & run bots that blanket deny tons of claims that should never have been denied. Automation is going to be their downfall.
Claims, Prior Authorizations, Appeals, Customer Service, UM, CM… you name it, they’re going to automate it.
notice the CM and UM Automation jobs that were just posted within the past week.
it won’t be full on AI, AI will take a large portion, but they will need people who know how to do the job to perform audits of the work AI does.