As part of its core strategy to be closer to the customer and to deliver its high-value services digitally, the insurer chose the Spixii Conversational Process Automation platform for its expertise to integrate with core systems and build business processes in a conversational way that can deliver end-to-end powerful automation with 100% accuracy and provide all the necessary audit trail for compliance purposes.
Automating the pre-authorisation process was perceived as a daunting task due to the high number of possible combinations of symptoms and treatments, which is why it was usually executed over the phone with the support of expert agents who guided users through all the steps. Digitally speaking, the previously adopted web forms were simply capturing free text input from customers, and the questions were too generic to power any process automation, let alone be user-centric when using a mobile.
Leveraging the Spixii Conversational Process Automation platform, the insurers designed the new customer journey with their business knowledge. On the Spixii platform, the journey and the business process are one and the same. In other words, the operational tasks that skilled agents would perform began to be automatically triggered by business logic based on the customer's position in the conversational journey.
The new process took the form of a powerful conversational self-service, which is a business process executed by an expert chatbot available 24/7. Exceeding expectations, the processing time was reduced 20-fold from 40 minutes to 2 minutes (0 for the agent and 2 minutes for the customer). At the same time, vulnerable customers could benefit from longer conversations, without lines being unexpectedly cut or agents having to end the conversation: they could respond at their own time, with no rush.
Available through desktop and mobile applications, more than 45% of all interactions resulted in 100% automated decisions, a figure that will only grow as more symptoms and treatments are better categorised. In comparison, the remaining 55% yielded better data capture, saving considerable time in manual processing.
With several hundred requests received per day, the self-service produces more than 75 uninterrupted working man-hours per day or more than 1,000 days per year. This has a significant impact on the resilience of the customer service operations.
Being 24/7 available, the new process handles requests as they come in, supports an unlimited number of conversations at the same time, and protects customers who get in touch out of working hours when call centres may not be available.
The operational tasks were automated, tested, and approved by the relevant stakeholders, including the compliance and governance team, providing total confidence in the automation's repeatability and consistency for this high-value process. Specifically, this approach validated the correct mapping of International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes for transmission to the decision engine.
In addition to the digital, operations and IT applications teams, the client's data and analytics team also has access to the Spixii platform to crunch valuable data and identify future improvements, with the ultimate goal of increasing the automation ratio.
