How things used to be
Statutory health insurance companies are subject to different rules to those imposed on companies in the private sector, as legislation in place significantly restricts their scope in terms of the range of services they can offer (product portfolio). Insurance companies want to set themselves apart from their competitors, so they focus on offering both an attractive price and a high quality of service. Online branches are a crucial tool for many insurance companies. They allow policy holders to access their information and claims easily at any hour of the day or night and from anywhere.
But if managers want to expand their online services by offering a live chat feature with administrators, they are quickly stretched to their limits. One reason is that providing this type of customer advice is resource intensive and prone to error due to the complexity of the subjects being discussed. Furthermore, working hour regulations, staff costs and staff availability mean that insurance companies cannot really offer a daily 24-hour chat service. Plus, few companies make use of the chance to combine case-closing advice together with the corresponding black-box processing. Online services are often limited to simple processes such as changing an address or bank details.
Then AI came along:
An AI application enables insurance companies to provide online customer services on a large scale, including case-closing advice. To do this, the system analyses the text in the chat and derives the issue from it. Targeted questions help the application to guide the policy holder through the entire conversation and to give case-closing advice (for example, fully processing a claim including the decision as to whether it is approved or denied) based on the information acquired during the conversation. Customers can upload any documents they have scanned that are necessary for the process such as income statements or claim documentation via the chat window. The AI solution detects the content of these documents and can read the information contained in them before then using it directly in the process in question. The system can also access customer-specific information stored on the production systems, which it can use in the conversation with the customer.
If needed, the application will call in a customer advisor who will continue the consultation. The policy holder experiences a seamless and comprehensive consultation process.
The situation today
Thanks to AI, insurance companies can give their customers tailored advice, even when dealing with complex matters. This means companies can improve their service offer during peak times and outside of regular working hours in particular. It also offers another efficient approach to process automation and black-box processing.
Michael Schmal, Manager Business Consulting
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