Information Systems and Organisational Learning in the Nigerian Health Insurance Industry: A Grounded Theory Investigation

Information systems as enablers of organisational learning in insurance companies have been studied extensively in high-income country contexts, yet the specific configurations through which health insurance firms in Nigeria develop, retain, and apply organisational knowledge through information systems remain theoretically unexplained. This study employs a grounded theory methodology to develop a substantive theory explaining how information systems mediate organisational learning in the Nigerian health insurance industry. Theoretical sampling guided data collection through 56 semi-structured interviews with IT managers, claims processing staff, actuarial analysts, and senior executives at eight health insurance companies operating across Lagos, Abuja, and Port Harcourt. Constant comparative analysis and theoretical saturation principles were applied rigorously through multiple rounds of open, axial, and selective coding. The resulting grounded theory, designated the Adaptive Claims Intelligence Theory, explains how health insurers in Nigeria develop organisation-specific knowledge about disease burden patterns, healthcare provider behaviour, and fraud typologies through iterative cycles of claims data analysis, social knowledge exchange, and system adaptation. The theory identifies three core processes: data anomaly surfacing, tacit-to-explicit knowledge conversion through system documentation, and adaptive rule revision in claims processing algorithms. The study makes an original theoretical contribution to the information systems and organisational learning literature by generating context-specific theory from an underrepresented African industry setting. Keywords: information systems, organisational learning, health insurance, grounded theory, Nigeria.