NewNew: The enterprise guide to Agentic AI — 24 min read.

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Illustrative, anonymized engagements · Results vary by scope

7 of 48 use cases ·

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CX & Contact Center AIHealth Payers

Claims status IVA with member authentication

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.

Up to 45% containment · 25% AHT reduction on transferred calls
Genesys CloudKore.ai
CX & Contact Center AIHealth Payers

Conversation analytics for Stars and CAHPS lift

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.

Measurable Stars driver lift within 2 quarters
NICE CXone
Agentic AIHealth Payers

Appeals & grievances drafting agent

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.

50% cycle-time reduction on standard appeals
Azure OpenAI
Enterprise AIHealth Payers

AI governance & evaluation platform

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.

Standardized evaluations across every deployed model
Azure OpenAI
AI Business AutomationHealth Payers

Attachment intake for claims adjudication

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.

Cycle-time reduction on attachment-blocked claims
Azure OpenAI
AI Business AutomationHealth Payers

Provider-data maintenance automation

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.

Directory accuracy improvement · lower CMS risk
Azure OpenAI
CX & Contact Center AIHealth Payers

Health plan member services conversational assistant

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.

45–60% member inquiry containment · 20% lower AHT on transfers
Kore.ai
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