Learn how you can modernize your call center and member experience
Feature spotlights
Get started quickly
Use existing documentation, such as summary plan description documents, to configure the service and quickly start answering questions about health plan benefits eligibility.
IBM Cloud platform
Watson Assistant for Health Benefits is built on the power of the IBM Cloud. In IBM’s cloud, it’s all about YOUR data. The IBM Cloud combined with the Watson Data Platform helps you maintain ownership and protection of your data. We build the IBM Cloud for artificial intelligence services and cognitive technologies. Our cloud must protect your data, and it must enable our artificial intelligence.
Natural conversation
Watson Assistant, rated by Forrester Research as a conversational platform that "leads the pack", understands the questions posed in natural language by end-users. It extracts the underlying information required to search for answers on the back-end, then responds with follow-up questions and answers.
Intelligent reasoning
Can incorporate enterprise data in back-end systems (e.g. benefits, accumulator, member and provider databases) in order to find answers to questions, and guides front-end interactions to ask the right sequence of context-specific questions in order to provide the most accurate answer most quickly.
Understands medical terms
Translates medical terms like CPT and ICD codes into user-friendly terms, and vice-versa, without having to hard code the translation. For instance, the system maps a question such as “I need knee replacement surgery” to a CPT code or family of CPT codes that will be used in the search for answers on the back-end.
Branded to your portal
Watson Assistant for Health Benefits uses open APIs so that you can hook it right into your existing member or CRM portal.
How customers use it
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Member self service
Problem
As a member, I want an authoritative answer to whether my plan covers the procedures my doctor has recommended, plus additional questions on in/out network coverage, procedure costs, deductible balance and nearby providers, all within 5 minutes.
Solution
Watson-based virtual agents are always available to interact with your members using natural language and a conversational interface. This enables people to get the personalized information they need — when and where they need it.
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Agent assist
Problem
As a call center agent, I need to provide authoritative answers to member questions about their benefits entitlement without having to manually search different sources, all within less than 5 minutes.
Solution
Your call center agents can provide accurate, fast, consistent responses that are generated from an integrated data set that includes claims, accumulation, provider directories, clinical data and additional key information.
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Provider self-service
Problem
As a provider, I need to quickly understand my patient’s benefit plan coverage and any policies that apply so I can set clear expectations and help my patient navigate without having to hold on the phone for lengthy research.
Solution
Providers calling into member services regarding their patient’s benefits and coverage
will get the same consistently accurate responses and fast service the patient is getting. -
Head of client experience - call center operations
Problem
Executives need to quickly and easily see the impact to call volume (deflection), first call resolution, average call times and client experience. And they need to see conversation flow, what topics are discussed and how conversations are resolved.
Solution
The service can help you deflect calls to lower-cost, self-service channels, reducing agent training and call-handling time so you can optimize your call center talent and focus on delivering differentiated, such as concierge-level, service.
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