The rising population and the associated increase in lifestyle diseases have been affecting the Health Insurance Industry. These companies have adopted newer technology in the past few years to manage the rising costs and increasing demands. The Healthcare Industry was identified as the largest voice and speech recognition software based on their utilizations. As per the latest reports, AI in the healthcare industry is predicted to grow at a rate of 38.5% CAGR between 2024 and 2030.
One of the leading Payers in the USA has been grappling with many issues. These include managing claim rejections due to missing Coordination of Benefits (COB) information and coping with an overwhelming call rate straining their call center agents. The increasing call volumes often left the agents overworked, impacting their productivity and the quality of service they could deliver.
The Payer faced the daunting task of managing over 27 thousand employees, which proved insufficient in the face of growing demands. The challenges ranged from finding the right resources to retaining dissatisfied employees. The company turned to technologies like AI to alleviate this burden and ensure a more efficient operation.
From an operational perspective, the payers spent over USD 22 million managing simple calls to identify COB and insurance coverage statuses. This led them to consider virtual voice bots to manage redundant parts of calls like validation, which was taking over the time of call center employees.
The Payer needed to maintain its brand reputation by using an existing market leader in AI voice bot and chatbot development. They chose CirrusLabs because of our previous expertise and industry success stories. Our unique architecture and the efficiency of our proposed solution helped them believe in our methods of execution.
We helped them develop a strategic plan using Asterisk Open Source Diaplan, Linux Redhat, MySQL, and AWS. This plan, meticulously crafted to meet the payer's specific needs, included automating validations to minimize the work on the call center agents. The validated details are then passed on to these agents to ensure a smooth transition between the AI chatbot and its human counterpart.
The application was designed to identify customers' inclinations toward speaking to human counterparts. This allowed the company to manage customers' expectations effectively while maintaining operational costs. This payer's average customer happiness rate drastically improved as they could cater to customers based on their preferences, instilling a sense of optimism for the future.
The shorter wait periods for getting basic details like deductibles, co-payment, appropriate COB information, and claim statuses are also very convenient for customers. Additional advancements in technology ensure that our AI support agents sound human, which has also helped customers overcome their inhibitions towards these robotic calls.
The post-implementation AI customer support service has effectively helped the payer reduce operational costs. The Coordination of Benefits (COB) was always a problem for the payer before the implementation of these voice bots. However, using AI has helped payers efficiently manage the cost-sharing between the different payers. The nuanced intricacies handled by AI and delivered by voice bots saved the company around 50% in costs, equivalent to around USD 27 Million.
Previously, the payer’s customer support team received many inbound calls about validity, coverage, and insured amount. The operations for these simple calls cost the payer around USD 22 Million. With the implementation of the voice bots, the company was able to save most of this amount.
Additional features included real-time dashboards showing the performance of the outbound calling lists. All voice conversations were recorded for you to look over or consider. Additionally, the caller dashboards provided visibility to agent availability and the average call wait queues. This helped managers plan effectively and handle peak-hour requirements.
2X Productivity amongst Agents
Revenue Gains of over USD 50 Million
Saved Time by 50% for Completion of the same tasks
Automating an existing system is hard because, after automation, the quality of work and customer satisfaction levels must remain the same for clients. However, post our solution, the payer has received great customer feedback. The reduced waiting periods and the professional answering model by chatbots have enhanced the customer's overall experience. The payer has brought down their operational costs, which helped them retain their position in the top 5 players list amidst a very competitive market.
If your company struggles with similar issues and wants to enhance overall revenue while reducing operational costs, contact us for a customized solution.