Case Study: Health Insurance Company improves service experience with CognitiveScale

Health Insurance Company - Customer Case Study

CognitiveScale worked with a large U.S. health insurance company facing high volumes of service inquiries from members and providers across phone, web, app, and chatbot channels. The customer needed faster resolutions for complex questions about bills, EOBs, claims, payments, benefits, eligibility, and enrollment, while reducing the significant time and cost tied to each interaction.

Using CognitiveScale’s Cognitive Service Experience solution on its Cortex platform, the company implemented AI-powered insights to predict why callers were reaching out, recommend next best actions, and deliver guidance across call centers, portals, apps, alerts, and messages. CognitiveScale’s profile-driven approach helped create member, provider, and claim profiles to support omnichannel service and agent assist; the case study cites benefits such as reduced call time, call avoidance, improved service ratings, and potential savings of tens of millions of dollars.