Influencing Customer Experience with Intelligent Automation in healthcare

What companies define by customer service is changing every few years. And the contact center is one area that transformation has influenced heavily. For this reason, a brand is now defined by the level of customer satisfaction it holds. Especially in the healthcare insurance sector post pandemic, the communication customers have with the healthcare payer directly translates to customer lifetime value. A look at the chart below will tell you how contact centers have been digitally transforming and the key focus areas on the Customer Experience Management for the contact center.

Uniphore recently conducted a survey that gave out pretty interesting results.

• 40% of on-hold callers asking for pandemic response information said they were frustrated about the experience.
• Almost half (43%) of health helpline callers couldn’t reach an agent or provider.
• Over 60% said the information they received from the contact center was different from information they obtained from the news.

Even though these stats show that health helplines need to take action to improve their customer experience, not many organizations are ready to take the digital transformation plunge. This cycle makes your technical debt increase further and hence your automation debt. The survey also showed that 76% of those surveyed preferred to human assistance or in contact center terms “to speak to a live agent”.

Automating health helplines Intelligently for Self-Service

Digital transformation using Intelligent automation is an orchestrated approach that uses Artificial Intelligence (AI), Robotic Process Automation (RPA), Natural Language Processing (NLP) and sentiment analysis to enable callers for self-service. This integration has enabled organizations to deliver superior customer service by creating an ideal balance between humans and machines. RPA interacts with medical records in the back end to fetch and analyze data hence reducing call times of the customer and also saving time for the agents to do more meaningful work. All this results in reduced operational costs with performance that has improved manifold.

Why to automate?

The pandemic has put a pressure on healthcare payers in an unprecedented way. Although the tug-of-war between hospitals and payers is nothing new, a recent news article from KHN talked about how 100's of Millions of USDs exist in unpaid claims due in part to a new claims management system and claims processing changes. And this is just one of the challenges healthcare payers are facing today. Piled up with unprocessed claims are a heap of claim denials from leading payers. Directly affected by a claim delay or denial are disgruntled patients and plummeting customer experience.

The need for automation for healthcare payers is now more evident than ever. A breakdown of the process flow of the claims processes will show you the scope for up to 80% of automation. RPA can be leveraged to automate claims prior authorization increasing the overall speed of the claims processes.

What an Intelligent Automated Contact Center can do for you?

Let us look at a Medicare enrollment use case where RPA powered by Artificial intelligence takes over the contact center to provide enhanced, human-like experience to the caller.

• When a caller calls a healthcare payer’s helpline for Medicare enrolment, the voice bot answers the call and in a human-like manner asks specific questions to gather information of the enroller.
• The omni-channel 24*7 support of the virtual agents allow the customer to choose a channel of his/her choice. This includes voice, text, whatsapp, etc and the virtual agent also is trained to capture and record all communication from the caller.
• Unless specified by the caller, the virtual agent is trailed to complete the full enrolment process supported by automated systems in the backend.
• The sentiment analysis technology that is coupled with RPA recognizes the mood of the customer and provides a score. This gives a better picture of the need for additional servicing for an angry or unhappy customer.
• When a caller requests for a live agent, a single-pane window displaying all required information on the call and the caller is provided to the agent. This reduces time gathering information and increases productivity of the agent.
• This also increases job satisfaction of the agent also empowering him to do more meaningful work.
• Reduced dependency on live agents also allows them to work remotely reducing health risk and providing time flexibility to be available for servicing.
• Data analytics of the calls gives the payer insights on what the customers really want and focus to develop their customer experience strategy to meet the actual needs of the customers.

Lateetud has used Intelligent Automation to help large healthcare payers streamline their businesses and manage their claims traffic better. While there is a large group of payers still contemplating adopting automation, IA powered contact centers will continue to influence the growth of customer experience management for healthcare payers.