Use Case for Health Insurance Companies
The common objective for health insurance companies in their client interactions is to ensure:
– Improve Population Health: Improve patients/member health under the care of a hospital, practice, provider or organization.
– Improve Member Experience: Improve member experience through better service in every aspect of health. Improve user interaction on portal or mobile applications to actual patient experience in the hospital and post care follow up.
– Reduce Medical Costs: Strive to lower costs, improve administrative efficiency, prevent fraud, minimize hospital visits, counsel on new diagnosis etc.
Avenir can bridge the innovation, technology and service gaps in the health insurance industry and develop solutions that align with the three goals. Health Insurance companies struggle to provide basic functionality on their portals and apps. They are catching up to match the services in other industries. Bots can transform the customer experience.
Doctor and Hospital Finder – A Bot that provides members listing info of doctors, specialists, hospitals, and dentists based on proximity – covered under their plans and part of your network. Th app will enable users to find the earliest appointment date. The Bot will evaluate various parameters including, member preference, location, benefit plan, proximity etc.
Communicating Plan Benefits – Most Insurance buyers are not sure of the benefits covered under their plan. Questions about their co-pay, out of pocket, deductibles, yearly max out of pocket amount etc., require users to search multiple systems leading to complexity and confusion. Members would like to see estimates for some surgeries & treatments.
Managing Member Profile – Changing an existing profile is very cumbersome and painstaking. Members cannot manage and update their profile information such as address, phone number etc., and preferences to receive physical mails, phone calls to their home address or not. Simplifying the process by creating a good User Management module will improve customer satisfaction.