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CASE STUDY

Leading US payor cuts benefit verification call length by over a third

Infinitus’ partnership helped them shave significant time off of calls, increasing efficiency and saving costs.

Who — or what — is Eva?

Word had spread throughout one of the top payors in the US. Who – or what – was this “bot” that was suddenly calling its agents?

The payor had been receiving calls from something called Eva, verifying patient benefits. Not a bot, but instead an AI digital assistant, Eva made calls that were efficient, effective, and pleasant for their agents to receive. The payor, one of the country’s three largest, was impressed by the technology.

They wanted to know more.

image shows a conversation between Infinitus' AI digital assistant and a payor agent. The AI asks how the agent's experience was and the agent responds, "Absolutely amazing! Honestly, that call has been the best one I've had all day!"

More than a bot

The payor’s leadership reached out to Infinitus to understand more about its digital assistant – and whether there was a possibility to work together. Call operations are one of the payor’s largest challenges; in 2023 alone, they spent millions on “insurance staffing,” overhiring to avoid unmanageable call queues due to forecasting issues. In fact, for every one employee they knew they needed, the payor instead hired four employees to handle surge demands.

Right away, both sides recognized the potential to speed up benefit verification (BV) calls and, therefore, reduce the demand on the payor’s call operations teams.

Together, the payor and Infinitus forged a partnership that included a variety of efforts aimed to improve the efficiency of communication.

Payor benefits

Data sharing

Creation of an API for Infinitus to share data before a phone call as well as PDFs for data not available via API, so that Infinitus could parse the data to help cut call length

Phone support

Creation of a dedicated phone number for the payor to receive Infinitus calls

Employee training

Training for agents to become more efficient at handling calls from Infinitus

Call volume estimates

Call volume estimates helped the payor prepare for fluctuations, especially during January’s annual reverification period, when call volume can spike by 10x

What’s it like talking to Eva?

“It was wonderful talking to you Eva. I had a great time speaking with you.”

Mike

CarelonRx

“Absolutely amazing.
Honestly, this call has been the best one I’ve had all day.”

Brooke

Anthem

“It was awesome! It was my first experience with an automated machine.”

David

Blue Cross Blue Shield

“I’m amazed!
I never thought I’d see this happen, but I guess it’s here.”

Harry

Texas Health and Human Services

“It was no different than talking to a regular person.”

Justin

Blue Cross Blue Shield

“My experience was great. You are actually like a real human.”

Mary

Anthem

Aligned toward a common goal

Both Infinitus and the payor are striving to make BV phone calls a thing of the past. To start, Infinitus advised the payor on the specific data elements they could make available digitally that would most significantly reduce call time, and the payor got to work. The resulting digital connectivity has proven to significantly reduce the amount of time payor agents spend on calls from Infinitus.

Basic questions like plan-level information (e.g., group number, plan name) are determined before the Infinitus digital assistant even begins a call to the payor, allowing the digital assistant to cut straight to the more complex questions. And thanks to their Infinitus-specific training, the payors’ agents are prepared.

A true partnership

The two teams meet regularly, working to add additional capabilities and other features that benefit both the payor and healthcare providers. Today, Infinitus’ calls to this payor are an average of 34% faster than calls made to any other payor – at scale, which is saving the payor thousands of hours and significant costs.

At the same time, payor leadership has invited Infinitus Co-Founder and Company Lead Ankit Jain to educate their teams on AI numerous times over the years of their partnership, helping the payor’s teams to stay current with the latest technological advances.

The payor has been so impressed by Infinitus’ partnership and ability to reduce call volumes and time spent on the phone that the two organizations have begun to discuss how the Infinitus digital assistant might be able to help them with their own outbound call needs. Talks on how to implement Infinitus in a variety of use cases are ongoing.

Can Infinitus do the same for you?

Infinitus supports over a thousand therapies, procedures, medications, and tests, calling major medical insurers and pharmacy benefit managers on behalf of providers. The Infinitus digital assistant makes calls that are faster, more accurate, and often more pleasant than calls made by human callers – helping payors save on time and costs.

If you’re interested in exploring a potential partnership, start here by learning more about why payors love Infinitus, or see what payor agents are already saying about Infinitus.

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Together we’re putting more “care” in healthcare

Whether you’ve got a provider division that makes calls or not, payors get the benefit of partnering with Infinitus, too.