Introducing Agent Assistant

Member Service Simplified with Automated, Accurate Decision Making

Untapped Potential for AI in Health Plan Contact Centers

AI has undoubtedly already left its mark in streamlining mundane tasks and reducing call load for basic inquiries amongst health plan contact centers. Yet, there’s still untapped potential on how AI can better enable agents in navigating complex call handling without bias, error, or compliance risk.
Many AI contact center solutions leverage large language models (LLM) to support things like generated call summaries or conversational self-service bots. This unsupervised training approach presents challenges in complex call handling in highly regulated industries. There’s a black box of how decisions are made and no control of the output. Then the agent is still left with making decisions based on the options provided.

The Opportunity to Focus on the Contact Center Agent Experience

Contact center agents remain essential to the member experience, especially for high-touch service, and bots won’t replace the need for them any time soon. Their experience commonly suffers from not having the right data in one place – leaving them responsible to have the industry knowledge and source the right answer across a range of topics.
A KFF survey found that nearly half of insured adults who had a problem with their insurance said their biggest problem was not resolved to their liking or not resolved at all. Among the insured adults who had a problem, 53% said they contacted their insurance company in an effort to resolve the problem. There’s clearly more room to eliminate agent burdens with proper tools that enable faster and smarter decision making for better resolution outcomes.

Introducing Agent Assistant, an Industry AI Solution on Simplify Platform

At Virtical AI, we want to eliminate the agent guesswork and automate decision making to quickly resolve any and all member cases with full compliance. And what better way to innovate on the world’s #1 CRM platform, Simplify Platform, and continue transforming health plan contact centers?
Simplify Platform is a foundational CRM platform to centralize your teams and data for a 360 degree view of customers across business lines. They work with national and regional health plans to transform how service teams deliver value across every touchpoint. More recently, they introduced Service Cloud Einstein to auto-generate horizontal service replies and work summaries. Our approach complements Simplify Platform’s current capabilities with specialized industry AI models to simplify existing and future processes for member service.
Agent Assistant, our newest pre-built industry AI solution on Simplify Platform, automatically identifies caller intent and agent action. We eliminate the agent guesswork by controlling actions based on validated industry AI models versus generating agent response options vulnerable to error.
Below are three components we incorporate to provide scale and user-friendly contact center solutions on Simplify Platform.
  • 1. Industry AI Models: A repository of AI models that are trained with industry-specific data and specialized in contact center processes.
  • 2. Agent View: An intuitive interface to capture caller queries and deliver visual representation of complex data.
  • 3. Business Controller: The orchestration layer to understand the inquiry intent and pre-determine the types of data visualizations necessary returned by the industry AI models. Customers are able to configure, validate, and maintain business logic.
As we navigate integrating AI into health plan contact centers on Simplify Platform, there should be a continued focus on enhancing the agent experience for precision and compliance. Automated agent decision making to resolve member cases faster becomes a reality when combining the power of their secure CRM platform and our pre-built industry AI solutions.

Ready to learn more?

Let’s drive the latest innovation in AI for health plans, together. See Agent Assistant in action by requesting a demo here or contact sales@virtical.ai.
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