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NEW REPORT: Q&A with Mike Gualtieri, VP Principal Analyst at Forrester

Service Experience in Healthcare

The Healthcare Member, Patient or Provider journey through the service experience process can benefit greatly from personalized AI-powered insights. Proactive insights delivered at the right time via the right channel (mobile, web, call center, conversational AI, etc.) can alter the trajectory of these journeys to lower cost, more valuable, higher quality outcomes.

Service Experience Applications in Healthcare

  • AGENT ASSIST
  • SELF SERVICE
  • SERVICE INTERVENTIONS
  • INTELLIGENT CALL ROUTING

Insights are based on personalized profiles

CognitiveScale’s Profile of One is a 360-degree, temporal, longitudinal view of key entities (Members, Patients, Providers, Consumers, Agents, Claims). Profiles form a key foundation for personalized insights and proactive interventions.

Service Experience insights that scale

Supporting numerous inquiry types in Healthcare (claims, benefits, etc.), the Cortex Service Experience solution consists of several components: AI models; rules engines and algorithms; integration with enterprise IT systems, apps and more; and, measurement and learning ‘feedback loops.’ Scaling trusted solutions across an enterprise for multiple inquiry types and inquirer personas requires CognitiveScale’s AI platform, reusable assets and accelerators, and the ability to leverage Service Experience models and components (e.g. APIs and data schemas).

Agent Assist Support

Service Experience insights are integrated into existing call center solutions (e.g. CRM and IVR systems). Agents are presented with personalized insights the moment they take a call. For claim inquiry predictions, for example, for both Member and Provider inquiries, Agents have access to specific predictions about claims inquiries that then point to detailed prescriptive solutions such as narratives about specific service lines, reason codes, denied services, and bills. Call routing via IVR can also leverage these predictions to deliver a personalized order of routing options for an individual caller.

Self Service & Proactive Channels

Service Experience insights can greatly improve self service channels like chatbots, delivering the same predictions and personalized inquiry resolution direct to Members, Patients and Providers. Cognitive Interventions are highly contextualized (to an individual) messages from Service Experience insights delivered through the right channel (e.g. app notifications or email) at the right time per the preferences of the individual.

A low-code, assembly line of Service Experience solutions

CognitiveScale’s AI software enables clients to manage an assembly line for the development, deployment, management and optimization of numerous Service Experience solutions in order to implement and scale numerous AI-powered insights for different inquiry and inquirer types across an enterprise with disparate systems and processes (e.g. Commercial vs. Government call centers and data sources).

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