Healthcare financing in Africa is often undermined by inefficiencies in claims processing and widespread fraud. Manual verification processes delay reimbursements, strain patient-provider relationships, and increase operational costs for Health Maintenance Organizations (HMOs). Fraudulent claims, including inflated billing, ghost patients, and inaccurate coding, further threaten the sustainability of health insurance schemes. Integrating Artificial Intelligence (AI) into claims management offers a pathway to improve efficiency, transparency, and trust within African health systems.