Tugure Highlights the Role of AI in Health Insurance Cost Containment Strategy Amid Rising Claims

Bandung, July 9–10, 2026 – PT Tugu Reasuransi Indonesia (Tugure) reaffirmed its commitment to strengthening the capabilities of insurance industry players through a knowledge-sharing session organized by Tugure Academy. This session, themed "Cost Containment: High Severity – High Frequency," focused on cost control strategies in health insurance amid the industry's growing challenges.

Held in Bandung, the event was attended by representatives from eight of Tugure's business partners from insurance companies as part of the Company's ongoing efforts to strengthen collaboration, enhance professional competencies, and foster closer business relationships. The session featured Andang Nugroho, CISSP (Certified Information Systems Security Professional), a Cybertech practitioner, and dr. Kiki Oditya Gunawardhana, Group Head of Life at PT Tugu Reasuransi Indonesia, as keynote speakers.

In his presentation, Andang Nugroho emphasized that digital transformation is no longer merely an option but a necessity for insurance companies to respond to changing customer behavior, technological advancements, and the growing complexity of healthcare risks. At the same time, Indonesia's insurance penetration rate, which remains relatively low at 2.7%, indicates significant growth opportunities for the industry.

Despite the continued increase in health insurance premiums and greater utilization of healthcare services, improvements in industry profitability have yet to keep pace. The rising frequency and severity of health insurance claims continue to place considerable pressure on insurers' financial performance, making cost containment an essential strategy for improving operational efficiency and ensuring long-term business sustainability.

According to Andang, the adoption of Artificial Intelligence (AI) and Machine Learning (ML) offers an effective solution to combat waste, abuse, and fraud, which have become major contributors to escalating claim costs. These technologies enable insurers to identify unusual claim patterns, detect anomalous transactions more rapidly, and support more accurate, data-driven decision-making.

"As health insurance claims become increasingly characterized by high severity and high frequency, the insurance industry must shift from a reactive approach to a predictive one. The adoption of AI and Machine Learning enables companies to detect anomalies at an earlier stage, improve the quality of decision-making, and strengthen long-term business sustainability," said Andang Nugroho.

Beyond enhancing claims management, the implementation of AI and ML also delivers significant benefits in underwriting, product and customer profitability analysis, optimization of partnerships with hospitals and Third Party Administrators (TPAs), as well as the development of more targeted marketing strategies.

In the following session, dr. Kiki Oditya Gunawardhana delivered a presentation entitled "Cost Containment: The Key to the Sustainability of Indonesia's Health Insurance Industry." He emphasized that the primary objective of cost containment is not to limit policyholders' access to healthcare services, but rather to ensure that insurance benefits remain sustainable amid rising medical inflation, increasing loss ratios, fraudulent practices, and intense price competition within the health insurance market.

"Cost containment is not intended to reduce policyholders' rights to healthcare services. Instead, it aims to ensure that insurance benefits remain sustainable and accessible for all policyholders despite the pressures of medical inflation and rising healthcare costs," explained dr. Kiki Oditya Gunawardhana.

As a reinsurance company, Tugure plays a strategic role in supporting the sustainability of the insurance industry by providing risk absorption capacity, actuarial analysis, product development support, and strengthening the capacity of national insurance companies to navigate an increasingly dynamic business environment.

Through Tugure Academy 2026, Tugure hopes to further strengthen collaboration with its business partners in preparing the industry to address future health insurance challenges. By leveraging digital transformation and implementing effective cost containment strategies, the industry is expected to build a more efficient, sustainable, and value-driven health insurance ecosystem for all stakeholders.