This Article provides an overview of how AI Voice Agents can lower call center operating costs and also simultaneously elevate the brand perception and customer service reputation of the health plan or the TPA. These AI Voice Agents can automate routine inquiries like Claim Status, Eligibility Verification and Benefits Inquiries.

Introduction - Why optimize your call center now?

Health Plans and TPAs face intense pressure to lower operating costs. There are several reasons 1) Medicare (& Medicare Advantage) and Medicaid reimbursement rates are going down. 2) Commercial Groups are pushing back on decades of price increases. 3) Lucrative revenue sources like pharmacy rebates are drying up.

There is also an urgent need to elevate the member experience and improve the Net Promoter Score (NPS) . Newer products like level-funded, direct primary care and ICHRAs are directly competing with Health plans and TPAs and member experience is increasingly the source of competitive advantage.

The Answer - AI Voice Agent focused on Health Plans and TPAs

A modern LLM-Powered AI Voice Agent can transform the call center experience. It can answer all the calls received at the call center - whether they are from members or providers. Callers can speak in full sentences with the AI Voice Agent and describe the reason for their call in their own language.

If the call is a routine inquiry like verifying eligibility or getting claims status, an AI Voice Agent can easily engage callers in a conversational experience, provide the answers and complete the call. In order to fully automate or answer these calls, the AI Voice Agents needs to integrate with the Payer's backend systems. These include member and eligibility databases, the CCaaS System and the CRM System.

Also AI Voice Agents is no longer a technology that will only become practical in the future. Unlike other technologies, AI is gaining rapid acceptance and such natural conversational interactions are a reality today. This Generative AI based Voice Agent has already been implemented in some of the fast-moving TPAs and health plans.

Designing the AI Voice Agent to seamlessly handoff calls to Live Agents

Any Health Plan or TPA will want an AI Voice Agent that seamlessly integrates with the phone system or CCaaS platform being used. Modern CCaaS platforms include Five9, Genesys Cloud, Dialpad, Nice CXOne, RingCentral and Avaya.

The AI Voice Agent should be able to transfer a call over the PSTN to the appropriate queue in the CCaaS platform based on the reason for the call. And most importantly, when an Agent actually becomes available and is able to take a call that is transferred by the AI Voice Agent, the Agent should receive a "Screen Pop" of all the information or context of the interaction with the AI Voice Agent. The most frustrating thing from a user-experience standpoint is to design a system or process where the caller has to repeat information that was already provided to the AI Voice Agent.

Improving Productivity of Live Agents with real-time assistance

Even after the call is answered by the human agent,  the AI Voice Agent should continue to monitor and listen to the conversation between the caller and the Live Agent. In other words, it is not sufficient to just provide the context of the caller's interaction with the AI Voice Agent. It is also very important to guide and help the AI Agent in real-time. In order to do this, the AI needs to have access to the real-time audio stream, stream the audio to a Large Language model secured with adequate guardrails. As context, the LLM needs to be provided with internal knowledge-base or support articles as context.

Analyzing and Rating the end-to-end caller journey

After the call is answered by the human agent,  the AI Voice Agent should automatically extract sentiment and key audio and NLU metrics and also score or rate the interaction between the caller and the Live Agent for Quality Assurance purposes.

Are you at a Health Pan or a TPA? Call Casey, our AI Voice Agent today.

If you are at a Health Plan or a TPA? You can experience how  Casey, Voicegain's AI Voice Agent for Payers, interacts with callers in call centers today.

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Here is a link to experience our demo. All it needs is 5 minutes. In-depth instructions to interact with the Demo are provided on the website. 

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Voicegain is excited to announce the launch of Voicegain Casey, a payer focused AI Voice Agent that transforms the end-to-end call center experience with the power of generative AI. Voicegain Casey is a software suite of the following three Voice AI SaaS applications that helps a health plan or TPA call center improve operational efficiency and increase the CSAT and NPS (Net Promoter Score):

A. Voicegain Casey - Suite of Generative AI-Powered SaaS Applications

1. AI Voice Agent:

The AI Voice Agent replaces a touch-tone IVR with a modern LLM-powered human-like conversational voice experience. The AI Voice Agent can answer all calls that are received at a Health Plan or TPA Call center. It engages callers in a natural conversation and automates routine telephone calls like Claims Status, benefits inquiries and eligibility verifications. There is a very compelling business case to automate Provider phone calls in Health Plan and TPA call centers. Voicegain Casey has been specifically designed and developed for this goal. The AI Voice Assistant is also trained to perform HIPAA Validation and triaging of calls. So if the AI has not been trained to answer a specific question, it routes the call to the call center for live assistance.

2. CCaaS Integrated AI Co-Pilot : 

Voicegain AI Co-Pilot is a browser extension that runs as a browser side-panel of Call Center Agent's CRM. This Co-Pilot is integrated with the Contact Center/CCaaS platform used in the Call Center. When a call transferred by the AI Voice Agent is eventually answered by a Live Agent, all the information collected by the AI Voice Assistant is presented as a "Screen-Pop" on the Desktop of the Live Agent (also referred to as CTI). This CTI/Screen pop feature ensures that the front-line call center staff can continue the conversation from where the AI Voice Agent left off. In addition to this Screen-Pop, the AI Co-Pilot also guides the front-line call center staff in real-time by listening, transcribing and analyzing the conversation and providing real-time guidance . The AI Co-Pilot also generates a summary of the conversation within five seconds of the completion of the call. This automated summarization easily saves 1-2 mins of wrap-up time or after call work which is very common in these health plan and TPA call centers.

3. AI QA & Coach:

Voicegain AI QA & Coach is a browser-based AI SaaS application that is used by Team-leaders, QA Call Coaches/Analysts and Operations Managers in a call center. This AI SaaS app records, transcribes and analyzes the entire conversation. It measure the sentiment of the callers and computes the QA score. Voicegain uses the latest open-source reasoning LLMs (like LLAMA 3, Gemma) and closed-source reasoning models like o-3 from Open AI. With the power of modern reasoning models, almost the entire QA score-card (approximately 80% of the questions) can be easily answered using AI. This SaaS App also provides a database of all whole-call-recordings of the entire conversation of the customer - which includes the AI Voice Assistant part, the transfer to the specific Call Center queue and eventually the entire conversation between the Live Agent and the Caller.

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B. Integrations

Voicegain Casey requires the following 3 key integrations to help with automation and real-time assistance.

1. Contact Center Platform/CCaaS Platform

Voicegain Casey integrates with modern CCaaS platforms. Current Integrations include Aircall, Five9 and Genesys Cloud. Planned integrations include Ringcentral, NICE CXOne and Dialpad.

2. CRM Software

Voicegain Casey integrates with the CRM software of the Health plan or the TPA. This can be an off-the-shelf CRM like Zendesk or Salesforce. It can also be a proprietary/homegrown CRM. As long as the CRM is a browser-based SaaS application, this should not be an issue. Voicegain Casey AI Co-Pilot is a browser-extension that is installed in the side-panel of the same browser tab as the CRM. At the end of the call, the summary of the call is automatically generated and available on the browser extension within 5 seconds of the end of the call.

3. Eligibility & Claims

Voicegain Casey needs access to the member eligibility and claims data.

C. Demo and Additional Information

For further information on Voicegain Casey, including a demo, please visit this link

D. Give us a shout!

If you would like to understand Voicegain Casey in more detail or if you would prefer a detailed product demo over a Zoom video call, please do not hesitate to send us an email. You can reach us at sales@voicegain.ai or support@voicegain.ai

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