Elevance Health is deepening its use of artificial intelligence enterprise-wide, focusing on enhancements to its member services, clinical workflows and provider operations as part of long-term efforts to simplify care delivery and reduce costs.
Chief Digital Information Officer Ratnakar Lavu told Becker’s the company’s goal is “to keep the patient at the center and a focus on the experience, not technology for the sake of technology.”
Elevance’s strategy is among a broader industry shift among large insurers using AI not just for automation, but for personalization and decision support that spans both administrative and clinical processes.
Internally, Elevance is equipping its employees with new AI tools to streamline workflows and improve responsiveness. The company’s homegrown AI toolkit, Spark, enables employees to automate manual tasks such as document analysis and contract processing.
“We wanted our associates to create custom workflows,” Mr. Lavu said. “For example, if they’re working with provider contracts, Spark allows them to analyze documents and provide real-time feedback.”
Elevance has also partnered with OpenAI to offer employees an enterprise version of ChatGPT, along with offering AI certifications that include training in areas such as prompt engineering and advanced AI applications. More than 38,000 employees have already completed 66,000 courses through the company’s learning programs, and new benefits will begin rolling out later this year.
Within the company’s call centers, AI is already helping employees handle member interactions. Through an initiative called Call Center Assist, Elevance is automating about one million post-call summaries each month and routing them to the right resources to improve efficiency. The system also performs sentiment analysis after calls to identify whether members were satisfied and pinpoint where friction occurred.
Elevance’s AI-driven virtual assistant, integrated into its member app called Sydney Health, has also quickly become a centerpiece of its evolving digital member strategy. The assistant offers members a ChatGPT-like experience to ask questions about benefits, coverage and care options.
“Members can ask, ‘Do I have this benefit?’ or ‘Which provider should I go to?’ and the AI will actually answer that,” Mr. Lavu said.
The company uses around 500 personalized data points, including benefits, conditions, location and provider network data, to tailor its responses. According to early analysis, nearly 90% of users found the answers they needed through the virtual assistant or the app’s other digital tools. The top queries involve benefits, finding care and general insurance questions.
By the end of 2025, more than 10 million members will have access to the virtual assistant. Mr. Lavu said Elevance plans to expand the feature to its full membership of more than 45 million people in 2026.
On the provider side, Elevance is using AI to streamline prior authorization and clinical decision-making through its Health OS platform. The platform connects provider data, lab results and pharmacy information to give clinicians more insight into the patient. Elevance said it has reduced denials stemming from a lack of information by 68%.
“Health OS gives us a 360-degree view of the member,” Mr. Lavu said. “We provide deep insights to the clinician about the member and the next best action that they should take.”
“When a provider sends in a request for prior authorization, we can look at all the information,” he added. “Previously, it used to be manual. Now the AI actually looks at it and says, ‘I have enough information that I can actually approve this.'”
As Elevance continues to ramp up its use of AI across clinical and administrative settings, Mr. Lavu emphasized the company’s focus on “responsible AI,” an internal oversight initiative that guides all development and deployment efforts. The platform monitors for bias, hallucinations and performs regular testing to ensure new models remain aligned with ethical and regulatory standards.
“We want to ensure explainability and transparency,” Mr. Lavu said. “Every AI decision can be traced back to why it made that decision and how.”
On the company’s third quarter earnings call in October, CEO Gail Boudreaux touched on the efforts to expand AI infrastructure, telling investors that “tools like Health OS and our AI-enabled clinical support are already reducing friction, speeding decisions, and bending the cost curve.”
Elevance posted a net income of about $1.2 billion during the third quarter, up 17.8% from roughly $1 billion at the same time last year. The company reaffirmed its annual EPS guidance of approximately $30, signaling confidence in its long-term cost management and digital transformation strategy despite headwinds in certain markets.
The company also said it will continue to invest “several hundred million dollars” in initiatives that advance its strategic goals, including AI and digital tools that executives hope will boost productivity, reduce administrative waste and improve clinical outcomes.
“If we do this well, the entire U.S. healthcare system stands to benefit,” Mr. Lavu said.
