NewNew: The enterprise guide to Agentic AI — 24 min read.
Read →
7 of 48 use cases ·
Don't see your use case? Talk to us →Problem. Claim-status calls flood member services and are highly repetitive.
Approach. Genesys + Kore.ai IVA fronting the claims platform with knowledge-grounded responses and secure auth.
Outcome. Members self-serve status, EOB questions and denial reasons; agents focus on appeals.
Problem. Member experience drivers are buried in unstructured call and chat data.
Approach. Enlighten + custom topic models surface Stars/CAHPS drivers and coaching moments.
Outcome. Targeted coaching against measurable Stars/CAHPS drivers.
Problem. Appeals require case review, policy citation and template-consistent drafting on tight SLAs.
Approach. Agent assembles case timeline, cites policy, drafts decision letter for reviewer.
Outcome. Reviewers edit and approve rather than draft from scratch.
Problem. Rapidly growing set of AI use cases lacks a shared evaluation and governance baseline.
Approach. Central eval harness, model registry, red-teaming and PHI-aware guardrails across teams.
Outcome. Faster, safer rollout of AI use cases with defensible audit trail.
Problem. Claim attachments (op notes, EOBs, itemized bills) block adjudication SLAs.
Approach. IDP extracts key fields, aligns to claim, flags missing data before adjudication.
Outcome. Adjudicators receive complete, indexed attachments.
Problem. Provider rosters drift constantly, driving directory accuracy and CMS-compliance risk.
Approach. Automated ingestion, entity resolution and change detection with human review of conflicts.
Outcome. Higher directory accuracy at lower manual overhead.
Problem. Member services is flooded with benefit, claims and ID-card questions that are repetitive but require accurate, plan-specific answers.
Approach. Kore.ai IVA grounded in plan documents and integrated with claims and member portals for personalized, compliant responses.
Outcome. Members resolve common questions on their channel of choice and agents focus on complex benefit escalations.
Try our ungated ROI calculators for Contact Center AI and AI Business Automation — enter your own volumes and cost inputs, get an instant estimate, then talk to us to validate.
