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Why Technology Alone Can't Fix Healthcare
Why Technology Alone Can't Fix Healthcare

Forbes

time4 days ago

  • Business
  • Forbes

Why Technology Alone Can't Fix Healthcare

Vivek Jetley, president and head of Insurance, Healthcare and Life Sciences at EXL, a global data and AI company serving Fortune 500 firms. According to the AMA, "healthcare spending in the U.S. increased by 7.5% in 2023 to $4.9 trillion," putting us well on track for healthcare to account for some 20% of the U.S. GDP by 2032. Meanwhile, about 25% of that spending is estimated to be the result of waste. From administrative complexity and billing errors to outright fraud and abuse, the entire healthcare payments cycle is rife with opportunities to fix broken workflows and decrease patient, provider and health insurer frustrations. For the last decade or so, technology has been touted as the panacea to this problem. First, through predictive analytics and machine learning, and more recently through generative AI (GenAI) and agentic AI models that have promised to spot anomalies and red flags before erroneous claims are even paid, each technological evolution brings new promises to fix healthcare. Yet, wasteful healthcare spending just keeps rising. Where's the disconnect? Enterprise AI Initiatives Stuck On First Base One answer can be found in a recent survey my firm conducted of C-suite executives from the banking and finance, insurance, retail, utilities and healthcare payer industries. Seeking deeper insight into how large businesses are using AI and where they're encountering hurdles, we found that 60% of enterprise AI initiatives are still stuck in the pilot phase. Among the biggest barriers keeping them from progressing were talent shortages and data quality. These findings should resonate for anyone who has ever tried to deploy an off-the-shelf AI model to improve health insurance claims processing or monitor payment integrity. Although, the best large language models (LLMs) can ingest reams of data and immediately spot red flags and surface important insights, the whole thing falls apart once a generic model is set loose in a complex claims processing workflow that involves dozens of handoffs and incredibly specialized knowledge of health insurance, medical billing and claims data. It's why even a supercomputer like IBM's Watson failed (paywall) when it tried to tackle healthcare. That doesn't mean, however, that there's no place for AI in healthcare—quite the opposite. When deployed properly, AI is already transforming the way health insurers and providers manage payments. But it takes much more than off-the-shelf technology alone to make it work. The real key to extracting value from AI in healthcare comes from embedding specialized technology at critical points in the claims review and processing workflow and carefully choreographing all the parts. But it isn't something that can be done through technology alone. It also requires deep industry expertise and the ability to harness data from several different systems, many of which haven't historically talked to one another. Transforming Payment Integrity Let's look at the world of payment integrity, for example. This is the process health insurance companies and healthcare providers go through to ensure that the fees billed for healthcare services are aligned with the services rendered and the fee schedules outlined in the insurance policy. This isn't easy. Research suggests that about $266 billion is wasted every year due to administrative complexity. This complexity can cause miscoding or the inaccurate interpretation of Centers for Medicare and Medicaid Services guidelines and fee schedules, resulting in errors. The old way of screening for these types of errors was to deploy teams of registered nurses and medical coders to manually review all claims against existing policy details to search for inconsistencies. More recently, GenAI has been introduced to cover more ground much faster and more accurately than a human could ever do. However, simply being able to spot data anomalies with technology isn't enough. For these systems to truly add value, they must be constantly updated to reflect changes in fee schedules, standards of care and coverage policy details. Additionally, they must accurately distinguish between true errors and false positives, efficiently routing this information to the appropriate human reviewers for in-depth analysis. AI Isn't A Shortcut What, on the surface, may sound like a simple scenario in which an AI model is fed a bunch of rules and asked to find instances where those rules are being broken is actually an incredibly nuanced process that requires specialized technology and people who understand the workflow. To put this in context, if a specialized AI model processes 4 billion claims annually and 1% of those are flagged as errors that require further investigation, that 1% could translate to several million dollars in erroneous payments. But the AI is only valuable in that scenario if it's surfacing incredibly precise results. More often, companies that deploy off-the-shelf models to do this type of work end up with thousands of false positives and inaccurate interpretations that end up putting them back to square one, with manual reviewers scouring reports and a lot of money wasted on technology they don't trust. Like everything else in business, there are no shortcuts or replacements for deep industry expertise. The most powerful AI models may promise to save time, money and create seamless processes, but without the ability to embed those models deep into the fabric of an enterprise workflow, the model will be useless. Fortunately, many firms are finding that by developing highly specialized models and working with industry experts to deploy them, real breakthroughs aren't only possible, they're happening today. Forbes Technology Council is an invitation-only community for world-class CIOs, CTOs and technology executives. Do I qualify?

EXL Recognized as Market Leader by Everest Group in its Group Life Insurance and Benefits Core Technology Products PEAK Matrix® Assessment 2025
EXL Recognized as Market Leader by Everest Group in its Group Life Insurance and Benefits Core Technology Products PEAK Matrix® Assessment 2025

Associated Press

time6 days ago

  • Business
  • Associated Press

EXL Recognized as Market Leader by Everest Group in its Group Life Insurance and Benefits Core Technology Products PEAK Matrix® Assessment 2025

NEW YORK, July 23, 2025 (GLOBE NEWSWIRE) -- EXL [NASDAQ: EXLS], a global data and AI company, has been recognized by Everest Group as a Leader and Star Performer in the Group Life Insurance and Benefits Core Technology Products PEAK Matrix® Assessment 2025 – North America. The Everest Group report evaluated 15 leading providers of life insurance and benefits technology on their delivery of cloud-native infrastructure, advanced analytics, and configurable core systems that address the unique complexities of group life and benefits administration to their respective clients. EXL was recognized as a Leader for its deep domain expertise, growing library of automation and AI tools tailored for group life operations, and its ability to modernize large-scale platforms through analytic-driven insights. 'EXL brings deep domain expertise and digital capability to the group insurance administration space, underpinned by its integrated technology and operations model on the LifePRO™ platform,' said Vigitesh Tewary, practice director at Everest Group. 'Its ability to streamline administration and enhance service levels is further strengthened by proprietary assets such as MedConnection™, which support intelligent workflow processing, case management, and underwriting optimization. With modular capabilities across policy administration, billing, claims, and servicing, EXL aligns well with carriers operating in hybrid or multi-vendor ecosystems. The firm's expanding suite of automation and AI-driven tools enables dynamic decisioning, real-time validations, and workflow automation tailored specifically for group life operations. These factors have contributed to its recognition as a Leader in Everest Group's Group Life Insurance and Benefits Core Technology Products PEAK Matrix® Assessment 2025 – North America.' 'The North American group life insurance industry is experiencing a rapid wave of digital transformation. As a result, clients are on the hunt for tools that will allow them to supercharge their quoting, underwriting, billing, and payout management capabilities,' said Vivek Jetley, president and head of insurance, healthcare, and life sciences, EXL. 'We're proud to receive this prestigious recognition from Everest Group and look forward to continuing to help our clients provide precise, tailored group life services to their clients.' To read more about the Everest Group 2025 report, click here for the custom version of the report. For more information about EXL's insurance solutions, click here. About EXL EXL (NASDAQ: EXLS) is a global data and AI company that offers services and solutions to reinvent client business models, drive better outcomes and unlock growth with speed. EXL harnesses the power of data, AI, and deep industry knowledge to transform businesses, including the world's leading corporations in industries including insurance, healthcare, banking and capital markets, retail, communications and media, and energy and infrastructure, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have approximately 60,000 employees spanning six continents. For more information, visit Cautionary Statement Regarding Forward-Looking StatementsContacts Media Keith Little [email protected] Investor Relations John Kristoff +1 212 209 4613 [email protected]

EXL announces availability of EXL Code Harbor™ and EXL Smart Agent Assist™ in the new AWS Marketplace AI Agents and Tools category
EXL announces availability of EXL Code Harbor™ and EXL Smart Agent Assist™ in the new AWS Marketplace AI Agents and Tools category

Business Upturn

time16-07-2025

  • Business
  • Business Upturn

EXL announces availability of EXL Code Harbor™ and EXL Smart Agent Assist™ in the new AWS Marketplace AI Agents and Tools category

NEW YORK, July 16, 2025 (GLOBE NEWSWIRE) — EXL (NASDAQ: EXLS), a global data and AI company, announced the availability of its Code Harbor™ ('Code Harbor') and Smart Agent Assist™ ('Smart Agent Assist') solutions in the new AI Agents and Tools category of AWS Marketplace. Customers can now use AWS Marketplace to easily discover, buy, and deploy AI agents solutions, including EXL's AI-powered code migration and real-time conversational insights and agent assist solutions, using their AWS accounts, accelerating agentic AI integration initiatives. EXL's Code Harbor helps organizations streamline the code migration process by orchestrating multiple AI agents including those for code comprehension, data cleaning, data lineage, code conversion and code validation, resulting in accelerated delivery, reduced costs, and higher accuracy. EXL's Smart Agent Assist enhances customer service operations by orchestrating multiple intent recognition AI agents with real-time conversational insights, automated call summaries and smart audits that enable customer service centers to deliver personalized and efficient experiences in addition to improving first call resolution, boosting agent productivity and reducing average handling time. 'By offering Code Harbor and Smart Agent Assist in AWS Marketplace, we're providing customers with a highly scalable, efficient and compliant way to embed EXL's agentic AI solutions into their workflows,' said Anand 'Andy' Logani, executive vice president and chief data and AI officer at EXL. 'Our customers in insurance, banking and finance, healthcare, retail and other industries are already using these capabilities to improve workflows, reduce costs and deliver better customer experiences, demonstrating the real-world value of our agentic AI solutions.' Based on internal studies, Code Harbor helps customers reduce code migration time on average by 35% over manual migrations, while reducing code compute time and memory usage generally by 25% and driving a 10% reduction in query plans. Additionally, analysis shows that Smart Agent Assist delivers typically a 12-15% reduction in contact center agent handling time, enhancing overall resource utilization and minimizing after-call work, ordinarily leading to a 20% decrease in service costs. With the availability of AI Agents and Tools in AWS Marketplace, customers can significantly accelerate their procurement process to drive AI innovation, reducing the time needed for vendor evaluations and complex negotiations. With centralized purchasing using AWS accounts, customers maintain visibility and control over licensing, payments, and access through AWS. To learn more about Code Harbor and Smart Agent Assist in AWS Marketplace, visit To learn more about the new Agents and Tools category in AWS Marketplace, visit About EXL EXL (NASDAQ: EXLS) is a global data and AI company that offers services and solutions to reinvent client business models, drive better outcomes and unlock growth with speed. EXL harnesses the power of data, AI, and deep industry knowledge to transform businesses, including the world's leading corporations in industries including insurance, healthcare, banking and capital markets, retail, communications and media, and energy and infrastructure, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have approximately 60,000 employees spanning six continents. For more information, visit Cautionary Statement Regarding Forward-Looking Statements This press release contains forward-looking statements within the meaning of the United States Private Securities Litigation Reform Act of 1995. You should not place undue reliance on those statements because they are subject to numerous uncertainties and factors relating to EXL's operations and business environment, all of which are difficult to predict and many of which are beyond EXL's control. Forward-looking statements include information concerning EXL's possible or assumed future results of operations, including descriptions of its business strategy. These statements may include words such as 'may,' 'will,' 'should,' 'believe,' 'expect,' 'anticipate,' 'intend,' 'plan,' 'estimate' or similar expressions. These statements are based on assumptions that we have made in light of management's experience in the industry as well as its perceptions of historical trends, current conditions, expected future developments and other factors it believes are appropriate under the circumstances. You should understand that these statements are not guarantees of performance or results. They involve known and unknown risks, uncertainties and assumptions. Although EXL believes that these forward-looking statements are based on reasonable assumptions, you should be aware that many factors could affect EXL's actual financial results or results of operations and could cause actual results to differ materially from those in the forward-looking statements. These factors, which include our ability to maintain and grow client demand, our ability to hire and retain sufficiently trained employees, and our ability to accurately estimate and/or manage costs, rising interest rates, rising inflation, recessionary economic trends, and ability to successfully integrate strategic acquisitions, are discussed in more detail in EXL's filings with the Securities and Exchange Commission, including EXL's Annual Report on Form 10-K. You should keep in mind that any forward-looking statement made herein, or elsewhere, speaks only as of the date on which it is made. New risks and uncertainties come up from time to time, and it is impossible to predict these events or how they may affect EXL. EXL has no obligation to update any forward-looking statements after the date hereof, except as required by applicable law. ContactsKeith Little [email protected]

EXL announces availability of EXL Code Harbor™ and EXL Smart Agent Assist™ in the new AWS Marketplace AI Agents and Tools category
EXL announces availability of EXL Code Harbor™ and EXL Smart Agent Assist™ in the new AWS Marketplace AI Agents and Tools category

Yahoo

time16-07-2025

  • Business
  • Yahoo

EXL announces availability of EXL Code Harbor™ and EXL Smart Agent Assist™ in the new AWS Marketplace AI Agents and Tools category

NEW YORK, July 16, 2025 (GLOBE NEWSWIRE) -- EXL (NASDAQ: EXLS), a global data and AI company, announced the availability of its Code Harbor™ ('Code Harbor') and Smart Agent Assist™ ('Smart Agent Assist') solutions in the new AI Agents and Tools category of AWS Marketplace. Customers can now use AWS Marketplace to easily discover, buy, and deploy AI agents solutions, including EXL's AI-powered code migration and real-time conversational insights and agent assist solutions, using their AWS accounts, accelerating agentic AI integration initiatives. EXL's Code Harbor helps organizations streamline the code migration process by orchestrating multiple AI agents including those for code comprehension, data cleaning, data lineage, code conversion and code validation, resulting in accelerated delivery, reduced costs, and higher accuracy. EXL's Smart Agent Assist enhances customer service operations by orchestrating multiple intent recognition AI agents with real-time conversational insights, automated call summaries and smart audits that enable customer service centers to deliver personalized and efficient experiences in addition to improving first call resolution, boosting agent productivity and reducing average handling time. 'By offering Code Harbor and Smart Agent Assist in AWS Marketplace, we're providing customers with a highly scalable, efficient and compliant way to embed EXL's agentic AI solutions into their workflows,' said Anand 'Andy' Logani, executive vice president and chief data and AI officer at EXL. 'Our customers in insurance, banking and finance, healthcare, retail and other industries are already using these capabilities to improve workflows, reduce costs and deliver better customer experiences, demonstrating the real-world value of our agentic AI solutions.' Based on internal studies, Code Harbor helps customers reduce code migration time on average by 35% over manual migrations, while reducing code compute time and memory usage generally by 25% and driving a 10% reduction in query plans. Additionally, analysis shows that Smart Agent Assist delivers typically a 12-15% reduction in contact center agent handling time, enhancing overall resource utilization and minimizing after-call work, ordinarily leading to a 20% decrease in service costs. With the availability of AI Agents and Tools in AWS Marketplace, customers can significantly accelerate their procurement process to drive AI innovation, reducing the time needed for vendor evaluations and complex negotiations. With centralized purchasing using AWS accounts, customers maintain visibility and control over licensing, payments, and access through learn more about Code Harbor and Smart Agent Assist in AWS Marketplace, visit To learn more about the new Agents and Tools category in AWS Marketplace, visit About EXL EXL (NASDAQ: EXLS) is a global data and AI company that offers services and solutions to reinvent client business models, drive better outcomes and unlock growth with speed. EXL harnesses the power of data, AI, and deep industry knowledge to transform businesses, including the world's leading corporations in industries including insurance, healthcare, banking and capital markets, retail, communications and media, and energy and infrastructure, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have approximately 60,000 employees spanning six continents. For more information, visit Cautionary Statement Regarding Forward-Looking Statements This press release contains forward-looking statements within the meaning of the United States Private Securities Litigation Reform Act of 1995. You should not place undue reliance on those statements because they are subject to numerous uncertainties and factors relating to EXL's operations and business environment, all of which are difficult to predict and many of which are beyond EXL's control. Forward-looking statements include information concerning EXL's possible or assumed future results of operations, including descriptions of its business strategy. These statements may include words such as 'may,' 'will,' 'should,' 'believe,' 'expect,' 'anticipate,' 'intend,' 'plan,' 'estimate' or similar expressions. These statements are based on assumptions that we have made in light of management's experience in the industry as well as its perceptions of historical trends, current conditions, expected future developments and other factors it believes are appropriate under the circumstances. You should understand that these statements are not guarantees of performance or results. They involve known and unknown risks, uncertainties and assumptions. Although EXL believes that these forward-looking statements are based on reasonable assumptions, you should be aware that many factors could affect EXL's actual financial results or results of operations and could cause actual results to differ materially from those in the forward-looking statements. These factors, which include our ability to maintain and grow client demand, our ability to hire and retain sufficiently trained employees, and our ability to accurately estimate and/or manage costs, rising interest rates, rising inflation, recessionary economic trends, and ability to successfully integrate strategic acquisitions, are discussed in more detail in EXL's filings with the Securities and Exchange Commission, including EXL's Annual Report on Form 10-K. You should keep in mind that any forward-looking statement made herein, or elsewhere, speaks only as of the date on which it is made. New risks and uncertainties come up from time to time, and it is impossible to predict these events or how they may affect EXL. EXL has no obligation to update any forward-looking statements after the date hereof, except as required by applicable law. ContactsKeith Investor RelationsJohn Kristoff+1 212 209 4613IR@

EXL announces availability of EXL Code Harbor™ and EXL Smart Agent Assist™ in the new AWS Marketplace AI Agents and Tools category
EXL announces availability of EXL Code Harbor™ and EXL Smart Agent Assist™ in the new AWS Marketplace AI Agents and Tools category

Yahoo

time16-07-2025

  • Business
  • Yahoo

EXL announces availability of EXL Code Harbor™ and EXL Smart Agent Assist™ in the new AWS Marketplace AI Agents and Tools category

NEW YORK, July 16, 2025 (GLOBE NEWSWIRE) -- EXL (NASDAQ: EXLS), a global data and AI company, announced the availability of its Code Harbor™ ('Code Harbor') and Smart Agent Assist™ ('Smart Agent Assist') solutions in the new AI Agents and Tools category of AWS Marketplace. Customers can now use AWS Marketplace to easily discover, buy, and deploy AI agents solutions, including EXL's AI-powered code migration and real-time conversational insights and agent assist solutions, using their AWS accounts, accelerating agentic AI integration initiatives. EXL's Code Harbor helps organizations streamline the code migration process by orchestrating multiple AI agents including those for code comprehension, data cleaning, data lineage, code conversion and code validation, resulting in accelerated delivery, reduced costs, and higher accuracy. EXL's Smart Agent Assist enhances customer service operations by orchestrating multiple intent recognition AI agents with real-time conversational insights, automated call summaries and smart audits that enable customer service centers to deliver personalized and efficient experiences in addition to improving first call resolution, boosting agent productivity and reducing average handling time. 'By offering Code Harbor and Smart Agent Assist in AWS Marketplace, we're providing customers with a highly scalable, efficient and compliant way to embed EXL's agentic AI solutions into their workflows,' said Anand 'Andy' Logani, executive vice president and chief data and AI officer at EXL. 'Our customers in insurance, banking and finance, healthcare, retail and other industries are already using these capabilities to improve workflows, reduce costs and deliver better customer experiences, demonstrating the real-world value of our agentic AI solutions.' Based on internal studies, Code Harbor helps customers reduce code migration time on average by 35% over manual migrations, while reducing code compute time and memory usage generally by 25% and driving a 10% reduction in query plans. Additionally, analysis shows that Smart Agent Assist delivers typically a 12-15% reduction in contact center agent handling time, enhancing overall resource utilization and minimizing after-call work, ordinarily leading to a 20% decrease in service costs. With the availability of AI Agents and Tools in AWS Marketplace, customers can significantly accelerate their procurement process to drive AI innovation, reducing the time needed for vendor evaluations and complex negotiations. With centralized purchasing using AWS accounts, customers maintain visibility and control over licensing, payments, and access through learn more about Code Harbor and Smart Agent Assist in AWS Marketplace, visit To learn more about the new Agents and Tools category in AWS Marketplace, visit About EXL EXL (NASDAQ: EXLS) is a global data and AI company that offers services and solutions to reinvent client business models, drive better outcomes and unlock growth with speed. EXL harnesses the power of data, AI, and deep industry knowledge to transform businesses, including the world's leading corporations in industries including insurance, healthcare, banking and capital markets, retail, communications and media, and energy and infrastructure, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have approximately 60,000 employees spanning six continents. For more information, visit Cautionary Statement Regarding Forward-Looking Statements This press release contains forward-looking statements within the meaning of the United States Private Securities Litigation Reform Act of 1995. You should not place undue reliance on those statements because they are subject to numerous uncertainties and factors relating to EXL's operations and business environment, all of which are difficult to predict and many of which are beyond EXL's control. Forward-looking statements include information concerning EXL's possible or assumed future results of operations, including descriptions of its business strategy. These statements may include words such as 'may,' 'will,' 'should,' 'believe,' 'expect,' 'anticipate,' 'intend,' 'plan,' 'estimate' or similar expressions. These statements are based on assumptions that we have made in light of management's experience in the industry as well as its perceptions of historical trends, current conditions, expected future developments and other factors it believes are appropriate under the circumstances. You should understand that these statements are not guarantees of performance or results. They involve known and unknown risks, uncertainties and assumptions. Although EXL believes that these forward-looking statements are based on reasonable assumptions, you should be aware that many factors could affect EXL's actual financial results or results of operations and could cause actual results to differ materially from those in the forward-looking statements. These factors, which include our ability to maintain and grow client demand, our ability to hire and retain sufficiently trained employees, and our ability to accurately estimate and/or manage costs, rising interest rates, rising inflation, recessionary economic trends, and ability to successfully integrate strategic acquisitions, are discussed in more detail in EXL's filings with the Securities and Exchange Commission, including EXL's Annual Report on Form 10-K. You should keep in mind that any forward-looking statement made herein, or elsewhere, speaks only as of the date on which it is made. New risks and uncertainties come up from time to time, and it is impossible to predict these events or how they may affect EXL. EXL has no obligation to update any forward-looking statements after the date hereof, except as required by applicable law. ContactsKeith Investor RelationsJohn Kristoff+1 212 209 4613IR@ in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data

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