4 min read

3 Reasons Healthcare Payers Should Focus on Conversational AI in 2023

Yoni Levine
Yoni Levine Senior Business Development Representative
3 Reasons Healthcare Payers Should Focus on Conversational AI in 2023

Picture this. You’re a Chief Information Officer at a leading healthcare payer organization. It’s another hectic Monday, and your inbox is filled with email threads from your call center’s director, each addressing the same issue—an overload of member inquiries. 


Despite your best efforts to streamline operations and enhance member service, managing the sheer volume and complexity of these interactions remains an ongoing challenge. 


As you glance at the clock, you can’t help but wonder if there’s a better way to handle this. Enter Conversational AI in healthcare—an emerging technology that could be the answer to your problems.

The Evolving Role of Payers and the Need for Conversational AI

The role of payers in the healthcare landscape is more pivotal than ever. Insurance companies, government programs like Medicaid and Medicare, and other healthcare plans are no longer just financial intermediaries. Instead, they’re actively engaging with members, answering queries, resolving disputes, offering personalized plans, and becoming healthcare advocates.


This evolution, however, comes with its own set of challenges. The nature of interactions has expanded exponentially, resulting in an overflow of phone calls, emails, and messages from members seeking clarification about their healthcare coverage.


This spike in engagement isn’t just about quantity either; the conversations are becoming increasingly complex, requiring a deep understanding of individual health policies and regulations.


This is where conversational AI can help. By leveraging AI to handle both text and voice-based interactions, payers can ensure accurate, personalized responses, effectively addressing member needs while significantly reducing operational costs.


These aren’t mere conjectures. Here are some impressive statistics to back this up: By 2025, conversational AI adoption is projected to save businesses a staggering $11 billion in customer care costs. Further, AI chatbots can cut customer support costs by up to 30%. And a significant number of businesses (67%, to be precise) believe they stand to lose customers if they don’t implement conversational AI.


In the context of healthcare insurance, the stakes are even higher. Conversational AI not only brings financial benefits but also plays a crucial role in delivering high-quality member service—a key differentiator in today’s ultra-competitive market. With this in mind, let’s dive into three reasons healthcare payers should focus on conversational AI in 2023 and beyond.

Reason 1: Enhanced Engagement and Improved Member Experience

According to NICE research, healthcare payers have one of the lowest Net Promoter Scores (NPS) across all industries, with a current average in the mid-20s.

In healthcare, member engagement isn’t a one-size-fits-all concept. The interaction members have with payers fundamentally differs from those with their providers. While the latter are deeply personal, stemming from a patient-healthcare provider relationship, interactions with payers are more transactional, focusing primarily on insurance claims, coverage inquiries, and policy details.



Conversational AI can bridge this gap, transforming impersonal transactions into meaningful interactions. For instance, AI-powered chatbots on the payer’s website can answer real-time queries, provide policy information, and guide members through complex processes like claim submissions. They can even suggest personalized healthcare plans based on individual needs, bringing an element of personalization to the transactional relationship.


On the other hand, call center automation through voice-based AI can ensure seamless phone interactions. From addressing queries to resolving disputes, AI can handle various tasks efficiently, drastically reducing hold times and enhancing member satisfaction. In addition, the system’s ability to understand and respond to complex queries adds an element of human-like interaction, further enriching the member experience.

Reason 2: Boosting Efficiency and Streamlining Operations

According to several estimates, US healthcare payers process 2.4 billion claims a year. Processing these manually not only consumes significant time and resources but also exposes the organization to human errors and inefficiencies. Add to this the risk of employee burnout due to the monotonous nature of these tasks, and it’s clear that a more efficient solution is needed.


This is where conversational AI comes into play, adding a significant edge to operational efficiency within call centers for healthcare payers. It can automate routine tasks like claim status updates and pre-authorization of procedures, liberating staff to attend to issues that require more strategic attention.


Moreover, conversational AI opens the door to enhanced self-service options for members. AI-powered chatbots, for example, can assist members with tracking their claim status, updating personal information, or clarifying coverage benefits, reducing the demand on call center staff.


Lastly, AI-powered call center automation can improve operations by handling tasks like call routing and initial information collection (patient onboarding), accelerating service speed, and reducing member wait times.

Reason 3: Significant Financial Advantages

Let’s talk money. Every dollar counts in the world of healthcare payers, and it’s no secret that this industry has more than its fair share of expenses. As per the Center for American Progress, each year, healthcare payers and providers in the United States spend about $496 billion on billing and insurance-related (BIR) costs.

Source: Center For American Progress

Here are some specific ways conversational AI and contact center automation can boost financial performance:


  • Reducing Labor Costs: By handling routine inquiries and administrative tasks, conversational AI can reduce the need for human agents, especially for routine queries, leading to substantial labor cost savings.
  • Decreasing Training Expenses: With AI handling a significant portion of member interactions, payers can cut down on the time and resources spent on training new call center staff.
  • Improving Efficiency: Conversational AI can answer member queries 24/7, significantly increasing the call center’s capacity and efficiency without adding extra staff.
  • Lowering Error Costs: By reducing the risk of human errors in administrative tasks, such as claims processing, AI can prevent costly mistakes and rework.
  • Increasing Revenue: Enhanced member experience, thanks to personalized interactions with AI, can lead to higher member satisfaction and retention, indirectly boosting revenue.
  • Promoting Preventative Care: Conversational AI can send automated reminders for regular health checks or preventive care, potentially reducing the costs associated with treating advanced-stage diseases.
About the author
Yoni Levine
Yoni Levine Senior Business Development Representative

Yoni is a Senior Business Development Representative and an expert in all things US healthcare providers and payers, which is pretty ironic given that he's originally from Canada. Prior to joining Hyro's ranks, Yoni was an Olympic ski coach, and he brings that kind of commitment to excellence to everything he does.