Health insurance transformation

Case Study

Making the right call

How a health insurance leader cut through the clutter, to deliver a seamless customer experience


Helping the benefits outweigh the costs

With over 280 million members, one of the largest for-profit managed healthcare companies in the US was receiving hundreds of millions of calls at its contact center every year—many related to benefits. To help representatives respond to these queries quickly and correctly, we partnered with our client to create a customized natural language processing (NLP) and natural language search (NLS) platform, resulting in enhanced customer interactions and significant savings.

“You have a good approach to NLP. Great work with Stanford Labs.”

-Chief Digital Officer, Large for-profit managed healthcare company


A case of customer service complexity

Thousands of times a day, our client was receiving queries at its contact center about health plan benefits. Each call with a customer service representative lasted an average of 10 minutes, with an average cost of $5 per call. With different rules across different states, healthcare plans and healthcare products, information was not only cumbersome, but complex—and housed within a traditional document. This made searching for answers challenging and costly, to the tune of $150 million annually. The organization knew it needed a digital disruption—one that would usher in a more effective and efficient way to do business, and provide a superior experience for customers and employees alike.


We knew this wasn’t just a technology challenge—it was also a business one. Our team had worked with this client for many years, so right out of the gate, we had experts well-versed in navigating the company, the healthcare system and healthcare policies working together with top engineers. As we set about digitizing and extracting widespread benefits information, we also conducted onsite workshops with the client’s technology leaders and key audiences, such as members, providers and insurance brokers. By learning more about each stakeholder’s needs, we could customize an experience that would truly resonate with the people who mattered most.

We were also able to bring in academic and ecosystem partners through UST’s relationships with Stanford University and other product companies. Over the course of three to four months, we built an NLP and NLS platform based on our UST SmartOps intelligent automation platform. The AI-based system understood user queries and predicted responses with near-perfect accuracy. Armed with a new “Google”-like search engine, the customer service representatives would be able to locate the right benefits information in a fraction of the time.


A healthy savings in more ways than one

This new platform—developed using our industry-leading insights and co-creative approach—paved the way for a simpler, more seamless contact center experience. With reduced redirection and resolution rates, as well as dramatic time and cost savings, our client realized greater operational efficiency. At the same time, key stakeholders enjoyed more direct access to the critical health information they needed—and increased confidence in its accuracy.

And while this platform was built to solve challenges related to healthcare—and health insurance, specifically—it has proven to be quite versatile. From the automotive industry to financial services to self-service channels like virtual assistants and chatbots, our smart benefits platform can help businesses deliver quick, reliable information to millions of people in a cost-effective way.

Customer supported in year 1
Accuracy of responses
Projected annual savings for client

"The solution is terrific, and I am super excited."

- Chief Administrative Officer, Large for-profit managed healthcare company


A look inside our toolbox

When the right teams have access to the right tools and industry knowledge, great things happen. Learn more about the expertise and resources that helped us achieve success on this project.

Digital Transformation

Strategy, Implementation & Operations

Financial Services

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