The fund has begun the testing and implementation process of incorporating AI into its core business software, 'Sosys', to streamline health insurance claims management, call center, and other administrative tasks.
What you should know
The Social Security Fund (SSF) has started incorporating artificial intelligence (AI) technology into its digital systems to enhance service delivery and internal efficiency. The fund has begun the testing and implementation process of incorporating AI into its core business software ‘Sosys’ to streamline health insurance claims management, call center and other administrative tasks.
According to the fund, the use of AI will make services related to insurance claims of contributors easier and more effective. ‘Currently, thousands of insurance claims are coming directly to the fund from hospitals every day,’ says Roshan Koju, the fund’s information officer. ‘These claims are sometimes genuine or fake or even unwanted, and it is becoming challenging for us to manage them one by one. Now AI will verify this.’
According to Koju, since the fund has only 10 to 12 medical staff, each person has the burden of looking at more than 300 ‘claims’ a day. Addressing this challenge, he said that AI will make it easier to review insurance claims. AI will initially examine the ‘claims’ and provide suggestions, and then the medical team (doctors, paramedics) will look at them and proceed with the process.
The second use of AI is going to be in the fund’s call center management. As the publicity of social security increases, people's curiosity has also increased and many calls are coming to the call center, according to the fund's employees. This causes the phone to be busy and there is a problem of not getting a response. To solve this problem, preparations are being made to integrate technology so that AI can answer certain questions. If the questions fall within the 'pool' (range of certain questions) of AI, the machine will answer them. Technology is being developed so that employees can answer questions that AI does not know.
Koju informed that 'bots' are being used to facilitate processes such as loan disbursement and payment. He said that AI has brought ease to these processes for authentication or 'user verification'. The fund is currently testing or 'proof of concept' to see whether the new technology works in its core business system 'SOSIEM'. The fund claims that it is also preparing to use AI in the 'Open EMIS' system. He said that the entire system is being prepared by Nepal's IT companies and Nepali IT manpower. For this, the fund has been doing some work through 'outsourcing'.
‘We are trying to use AI in three areas, one is insurance claim management, the second is call center and the third is using bots for user verification in non-medical services,’ said Koju, ‘We are at the forefront in using AI at the government level.’ Koju said that the fund will work on the AI system further by the end of the current fiscal year 2082/83 and has taken the process forward to materialize several plans.
The current fiscal year’s budget mentions that the government will emphasize digital transformation and the development of AI technology. It has been said that an AI center will be established in collaboration with the private sector for research, use and expansion of AI and machine learning, and facilitation will be provided to promote the commercial use of AI.
The budget aims to emphasize the discovery, research, development and innovation of the latest technologies developed in the information technology sector. However, Social Security Fund officials have the experience that policy and structural obstacles remain the main challenges in the implementation of new technologies like AI.
‘The hospital services and foreign employment services operated by the fund are very critical services,’ said Koju, ‘If the system goes down and the service cannot be provided, people can lose their lives. Therefore, the system must be kept operational 24 hours a day. However, since we have a policy that data related to Nepali citizens cannot be stored in the cloud or must be stored locally, there is a risk that our service will be disrupted if the system goes down for some reason.
When the data center is down, service recipients do not receive the service and have to suffer their anger.’ Koju says that the long period taken in the procurement process is also another challenge.
