Health insurance and technology leaders are optimistic that Artificial Intelligence (AI) and real-time data will enhance healthcare quality, reduce costs, and expand insurance access in Kenya. AI is set to improve decision-making, streamline operations, and make health insurance more accessible for Kenyans.
At The Digital Pulse CEO Roundtable 2025, hosted by M-TIBA, industry leaders from health insurance, reinsurance, technology, and healthcare explored practical AI-driven strategies to transform healthcare and insurance.
This year’s theme, “Connected Intelligence: The Future of Data, Tech, and AI in Health Insurance,” focused on how AI and real-time data can simplify health insurance. The discussions led to actionable ideas for managing costs and risks, shifting from reactive to proactive care, and strengthening partnerships across the healthcare ecosystem.
“AI is the buzzword of the day. At this year’s event we focused on turning innovation into real tangible benefits for health insurance,” said Pieter Prickaerts, CEO of CarePay International and M-TIBA.
“Already, AI is proving most valuable in administrative tasks like approvals and claims processing, but more benefits of data and AI are expected in the near future.”
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Early AI applications in health insurance—such as automated pre-authorizations and claims processing—have significantly improved efficiency.
M-TIBA’s data-driven platform has shortened payment cycles up to 95%, while healthcare costs have dropped by up to 15%, allowing members to stretch their coverage further. Members can also track claims in real-time, improving transparency and flexibility in decision-making.
Njeri Jomo, CEO of Jubilee Health Insurance, highlighted how AI is optimizing pricing, enabling premiums as low as KES 500 per month.
“AI has streamlined our administrative processes, allowing 80% of claims to be processed faster while maintaining accuracy, efficiency, and predictability,” she said.
AI is also enhancing real-time monitoring for healthcare providers, preventing duplicate treatments, detecting anomalies, and flagging high utilization in real time. This fosters better collaboration between providers and insurers, leading to improved patient outcomes and cost savings.
Looking ahead, experts predict AI will play an even greater role in diagnostics, treatment recommendations, and drug development. However, human oversight will remain essential to ensure AI-driven decisions align with ethical and medical standards.
“AI is transforming healthcare much like electricity revolutionized industries,” said Dharmendra Jain, CEO of Actnable AI.
“To unlock its potential today, we must take immediate, actionable steps, such as mapping the member’s health insurance journey to identify areas where AI can enhance the patient and member experience.”
“AI is strong in areas like reading, summarizing and education, but when it comes to complex mathematics and data calculations, even the latest models are still struggling. In health insurance, we should focus on where AI truly excels, implementing it for tasks that can streamline administrative processes and improve efficiency,” said Ezekiel Macharia, Managing Director of Kenbright.
“The industry must not expect AI to solve everything overnight. Instead, we should start with proven, high-impact use cases,” he added.
As AI advances, it is expected by experts to assist in diagnosis, treatment planning, and even surgery. By reducing time spent on administrative tasks, healthcare professionals can focus on patient care and support more individuals.
The opportunity for collaboration in AI-driven innovation is vast. Industry leaders agree that leveraging connected intelligence can drive the development of simple, affordable solutions, expanding insurance coverage for underserved Kenyan populations.
