| dc.description.abstract | The automation of health claims and the implementation of an advanced claims management system plays a
crucial role in ensuring high-quality healthcare for patients. Claims processing is a vital function for insurance
companies, as the speed and convenience with which claims are handled directly impact the overall reputation
of the insurer. In Kenya alone, approximately 30 million medical claims are processed annually. However, an
inefficient claims management system presents significant challenges, including high costs, time consumption,
and increased instances of medical fraud. This research examined the effect of digital transformation strategy
on the performance of e-claims systems at the National Health Insurance Fund in Kenya. The study objectives
included assessing the impact of integrating digital technologies, evaluating the effect of data security
compliance, examining the role of user experience, and determining the effect of interoperability with external
systems on the performance of e-claims systems. The study was grounded in the Innovation Diffusion Theory,
Resource-Based Theory, and Digital Business Transformation Framework. A case study research design was
employed, targeting 166 employees at the National Health Insurance Fund headquarters. The sample size was
determined using Yamane’s formula, resulting in 95 respondents. Stratified random sampling was utilized as
the sampling procedure. Data analysis was conducted using SPSS version 27.0, encompassing preliminary
analysis, and descriptive and inferential analysis. Measures of central tendency (mean, median, and mode)
were employed to describe the data set, while measures of variability (range, standard deviation) will assess
data dispersion. Pearson Correlation Analysis and multiple regression models were employed. The results
were presented using tables and figures. The study results found that integration of digital technologies
significantly affects the performance of E-Claims Systems (B = .646, p < .001); data security compliance has
a significant and positive effect on the performance of E-Claims Systems (B = .528, p < .001); user-experience
has a significant and positive effect on the performance of E-Claims Systems (B = .618, p < .001) and that
compatibility with external systems has a significant and positive effect on the performance of E-Claims
Systems (B = .703, p < .001). The study concludes that the integration of digital technologies, data security
compliance, user experience, and interoperability with external systems is integral to enhancing E-Claims
Systems performance at NHIF. The general recommendation for the study is to prioritize the integration of
digital technologies, ensure data security compliance, optimize user experience, and foster interoperability
with external systems within E-Claims Systems at NHIF. | en_US |
