Case Study
Digital concierge: UST delivers AI-driven conversational search to provide personalized experiences for health insurance plan members
OUR CLIENT
Our client is a leading healthcare payer in the managed healthcare field. The company is dedicated to improving lives and communities through innovative health benefits and services.
THE CHALLENGE
Overhauling self-service search capabilities for health insurance plan members
The company wanted to provide insurance plan members with streamlined self-service access to accurate healthcare information to reduce customer service calls. Members struggled to find relevant information across benefits, claims, care options, and cost estimates due to the complex and confusing navigation and siloed systems. The insurance payer needed a partner with healthcare technology leadership to guide this transformative project, select the appropriate technology, and design architecture and systems that deliver more intuitive, efficient navigation to maximize the use of eligible benefits, increase customer satisfaction, reduce support calls, and lower operating costs.
THE TRANSFORMATION
Implementing conversational AI for health benefit clarity and improving decision-making
UST technology experts integrated the company’s healthcare app with a platform that leverages GenAI and automation. The multi-agent AI solution uses large language models (LLMs) and a conversational AI interface to help members search across multiple domains, as well as structured and unstructured data sources, using natural language and personalized search prompts based on member profiles, demographics, medical records, and contextual cues. This sophisticated solution provides comprehensive support for health plan members. By augmenting answers with summaries and explanations of medical terms, search responses are more accurate compared to traditional chat solutions, enabling people to make more informed healthcare decisions. Now, members can use streamlined, intuitive, self-service functionality within the company’s web and mobile app to find the insurance and healthcare information they need.
THE IMPACT
Delivering personalized healthcare information and enhancing healthcare member experiences
The successful AI-powered digital transformation project delivered these impressive results:
- Significant reduction in customer service calls—thanks to the digital-containment efficiency of the AI-driven search solution that allows members to find information without escalating inquiries to live support agents
- Increased adoption of conversational searches—with efficient conversational searches through follow-up prompts, proactive/predictive caching, and prompt tuning
- 4+ out of 5 feedback ratings—because the AI-driven user experience delivers human-like interactions to help health plan members easily find the personalized information they need
Does your company want to explore the possibilities of AI-driven solutions to streamline processes, reduce costs, and enhance customer experiences? Connect with a UST expert.
RESOURCES
https://www.ust.com/en/ai-survey