Revolutionizing Healthcare: Driving Results with Extractive Summarization and Eligibility BOT Implementation
Client Overview
The client is a pioneering healthcare enablement organization headquartered in the United States, focusing on transforming the healthcare experience for members, payers, and providers. The client offers end-to-end health plan management services, combining technology and domain expertise to drive better health outcomes, reduce administrative burden, and improve operational efficiency. With a growing portfolio of national and regional health plans, they are committed to delivering high-quality service on a scale.
Reimagining Member Experience Through Intelligent Automation
In an increasingly complex and regulated healthcare ecosystem, the client faced significant operational challenges in their customer service workflows.
Customer Service Representatives (CSRs) were spending an average of 10–12 minutes per call due to manual navigation through over 1,000 benefit documents.
Additionally, summarization notes fed into the CRM lacked consistency and critical insights, negatively impacting member satisfaction and resolution times.
To streamline operations and elevate service delivery, the client sought an AI-powered solution to reduce Average Call Handling Time (AHT), enhance call summary quality, and improve response accuracy through automated benefit data extraction.
Client Requirements:
Reduce Average Call Handling Time (AHT):
Bring AHT down from 10–12 minutes to 6–8 minutes to boost member satisfaction and reduce operational strain.
Enhance Call Summarization Quality
Ensure consistent, accurate, and
actionable summaries reflecting
each call's core outcomes and
member needs.
Automate Benefit Information Retrieval
Eliminate manual document searches by CSRs and enable instant access to relevant plan details from over 1,000
Summary Plan Documents (SPDs).
Indium Delivers an AI-Powered Documentation Intelligence Platform
Indium partnered with the client to deploy an AI-first solution tailored specifically for healthcare operations, combining extractive summarization, contextual data extraction, and document intelligence.
Here’s how Indium addressed their needs:
Extractive Summarization of Call Transcripts
Leveraged OpenAI's GPT-3.5 Davinci model to generate intelligent, structured
summaries of customer call transcripts. Indium built a Minimum Viable
Product (MVP) to fine-tune model outputs for business-relevant prompts,
significantly improving the quality of notes ingested into the CRM platform.
Smart Eligibility BOT with Contextual Extraction
Utilized fine-tuned GPT models to extract benefits grid data from SPDs.
Employed a document pipeline with overlapping chunking and context
injection strategies to handle large, complex documents and accurately
surface eligibility data in real-time.
Optimized Cost-to-Performance Strategy
Designed a cost-effective model for summarization and extraction
workflows, considering token consumption, audio length, and inference quality to ensure scalability across high call volumes.
Indium Drives Tangible Outcomes in
Engineering Productivity and Accuracy
9–10 Minute Reduction in Average Call Handling Time (AHT)
Streamlined information access and intelligent summaries reduced call durations, helping CSRs focus more on member empathy and faster resolution.
Improved Summarization Quality with Key Outcomes Highlighted:
Summaries now consistently included accurate, relevant details, improving post-call actions and enabling better analytics.
99% Accuracy in 90% of Member Queries
The eligibility BOT achieved near-perfect accuracy for most benefit-related questions, empowering CSRs with instant answers and driving first-call resolutions.
About Indium
Indium is an Al-driven digital engineering company that helps enterprises build, scale, and innovate with cutting-edge technology. We specialize in custom solutions, ensuring every engagement is tailored to business needs with a relentless customer-first approach. Our expertise spans Generative Al, Product Engineering, Intelligent Automation, Data & Al, Quality Engineering, and Gaming, delivering high-impact solutions that drive real business impact.
With 5,000+ associates globally, we partner with Fortune 500, Global 2000, and leading technology firms across Financial Services, Healthcare, Manufacturing, Retail, and Technology-driving impact in North America, India, the UK, Singapore, Australia, and Japan to keep businesses ahead in an Al-first world.
