A Brief Overview

“When customer comes first, the customer will last.” — Robert Half. Agile Soft Systems is a customer centric organization and exceptional customer experience serves as the common denominator in every software solution we implement.

Our customer, a leader in Health Insurance, had grown to be among the top five of the most preferred company in the sector. With over thirty years in the industry they had surpassed the giants offering the best products in Health Insurance across the country.

They had heavily invested in developing the best products and marketing them aggressively, and their initial success was unmatched.

But the past decade however saw the Health Insurance company's growth decline gradually, and the condition worsened post pandemic. However, they were prepared to fight back with full zest, and had with enormous effort, collected and analyzed enough data that pointed to a single problem that they needed help with.

Agile Soft Systems with years of experience in modern application development helped solve the problem for the customer, and also accelerated their previously slowing down growth by a good margin.

Challenges faced by the Health Insurance Company.

The healthcare insurance provider had scaled very rapidly than estimated, and the required customer support did not scale proportionately despite outsourcing the work to leading BPOs, and on-boarding new vendors from time to time. Their customer retention rate was buckling under the pressure of their growing customer base.

Here are some business problems the Insurer was facing.

Complex Policy Information and Benefit structures:

The company's health insurance policies were daunting to many customers due to complex terms, coverage details and exclusions. The consumers struggled to make informed decisions about their coverage, leading to dissatisfaction and confusion. Further complex benefit structures and copayment terms added to the confusion and unexpected payments frustrated them.

Ineffective Communication and Policy Management:

Sometimes, customers were uninformed about the changes in policies regarding renewals and premiums, as the messages and updates were not communicated through appropriate channels. This led to dissatisfaction among customers which results in attrition.

Existing customers wanting to make changes to their policies, found the process to be utterly cumbersome. Inefficient policy management, or the lack of support frequently led to potential errors.

Claims Processing Delays:

Lengthy and complex claims processing resulted in delays, causing frustration for policyholders. Customers perceived the claims process as burdensome, leading to dissatisfaction and an overall negative experience.

Lack of Personalization:

In today's digital age customers expect a seamless online experience. Also, since customers' experience a great level of personalization on shopping platforms, they expect Insurance providers to offer the same level of customer experience.

This drawback was seen as a major setback and the consumers preferred to go with Insurance providers who offered a better digital experience.

Technological Challenges

Besides the problems encountered at a Business level, the Insurer also faced some technical challenges that are outlined below.

Existing Customer Platform.

The Insurance company had adopted cloud solutions and latest software development practices, but a limited Customer Relationship Management application restricted their scope and growth. The relevant channels of communication were in place, but lacked in integration making it difficult for the support staff to assist the customers.

Weak UX and lack of automation.

The user journey was not designed well, and was ridden with several problems which led to customers frequently dialing in for support at several stages of the process. The lack of self service capabilities and automation resulted in a cumbersome experience and had a majority of the users abandon the process midway.

Also, a sub optimal User Interface design was leading to a negative perception of the brand, and customers thought of it to be below par as compared to leading Insurance Providers.

Solutions for Customer Experience problems

The customer's thorough investigation pointed to a single problem — poor customer experience. However this problem was multi pronged and had its arms in various parts of the process: marketing, sales, policy management and customer support.

Problem analysis through a 360° Design Workshop

Agile Soft Solutions understood that though on the surface the problem appeared to be related to Customer Support alone, the root cause lay in how each part of the entire operation, from marketing to sales, and even policy management worked. So we decided to conduct a four day 360° Design Thinking workshop to identify and analyze the problems all stake holders faced: customers, business stakeholders and the support team.

Our expert team understood that a seamless User Journey had to be created and so we began crafting User Stories which included all sub processes from perspectives of all the stake holders.

Customer Data Platform.

Most of the problems the Insurer faced was due to a lack of a robust CDP, or a Customer Data Platform. Having a comprehensive view of each customer was crucial, as this helped the Insurer understand their behavior and preferences which would help them serve the customers better.

Moreover, technically it would be difficult for us to employ ML and AI into the existing system required to enhance Customer Experience.

Agile Soft Systems chose Pimcore, an open source Customer Data Platform to build a custom solution for the Insurer. The customizable and scalable Digital Experience Platform (DXP) could be well integrated with other existing systems.

Pimcore is used by companies to create a unified view of customer data from multiple sources, personalize marketing messages, and deliver a consistent customer experience across all channels. We used Pimcore to manage all aspects of a digital business, including product information management (PIM), digital asset management (DAM), e-commerce, content management (CMS), and customer data management (CDP).

Pimcore was used to create a unified view of customer data from multiple sources, such as CRM systems, policy administration systems, and claims systems. This helped the insurance company to better understand their customers and to provide them with more personalized experiences. It also comes equipped with a product recommendation engine which is a game changer in sales.

Agile Soft created a personalized customer portal where customers can log in to view their policies, file claims, and make payments. It was integrated with other systems: CRM systems and policy administration systems, providing the customers with a seamless experience.

Upgrading from a CRM to a full blown DXP helped us resolve several process problems and enhance the overall Customer Experience for Policy holders.

Integration of Conversational AI

Upgrading from the existing CRM to a full blown CDP had us improve the system substantially. But it was a battle half won. The DXP had reduced manual intervention up to a great degree. But Agile Soft Systems was adamant to augment the performance even more, and Conversational AI was the solution that we believed could get us there.

Conversational AI uses Natural Language Processing to simulate human interactions. In simple terms, you could have ChatBots, Virtual Bots and Voice Bots that understand context, intent and emotions of the customers and respond to their queries with intelligence. It personalizes conversations and even understands multi-turn conversations where it's able to remember the context throughout the conversational thread just like humans.

Our idea was to reduce customer support cost by using Conversational AI Chatbots and VoiceBots to work independently of human resources and to work alongside humans when required, typically as CoBots.

The conversational AI tech stack

The following tech stack was chosen based on the preferences and the requirement of the project. The technology solutions also was chosen with scalability and implementation in mind.

Rasa Agile Soft chose an open source Conversational AI framework, Rasa, to integrate into Pimcore. The idea was to reduce customer support cost, bringing it down to the minimum. Rasa is flexible, extensible and could be used to build a wide variety of conversations. It's also well documented with a large community of contributors.

Mycroft AI With Rasa, we used Mycroft AI for speech to text and text to speech synthesis. It's open source and has all the components required to build voice applications. It has a dialogue manager, is fast and has a good level of accuracy. We chose not to go with Google Cloud Speech-to-Text and Text-to-Speech to avoid vendor lock-in.

spaCy spaCy is an open source NLP library which is used to perform a range of NLP tasks including tokenization, lemmatization, named entity recognition, part-of-speech tagging, dependency parsing, and more. It's known for its speed, accuracy, and flexibility.

React Agile Soft Systems has a team of expert React Developers experienced in building complex and large scale applications. It was thus an easy choice for us between React and Rasa X to build the front end of the ChatBots and VoiceBots.

Also, the entire interface, customer and client facing side is built using React.

Business advantages of implementing CDP and Conversational AI

Increased Customer Experience and Support:

The customer portal with a well defined and clear user journey, along with personalization enhanced the Customer Experience to the highest degree. Conversational AI integrated in to the system has now sped up customer support processes efficiently without manual intervention by human agents.

In case of extremely complex problems the cases are routed to the most suitable agent. Crucial processes are handled by agents with the help of CoBots to assist them in the process, which leads to less errors and efficiency.

Increased sales:

Pimcore helps the Insurer to create targeted marketing campaigns based on customer data. The CDP enablement advanced customer segmentation based on various criteria, such as demographics, behavior, and preferences. This segmentation allows the insurer to target specific customer groups with relevant products, services, and messaging.

For instance, the insurance company could now identify customers who are due to renew their policies and can send them personalized renewal offers.

The DXP platform came built with a robust product recommendation engine to create personalized product recommendations for potential customers.

Conversational AI integration helped automate not only selling of insurance products but up-selling and cross-selling of features as well.

Reduced costs:

The newly integrated system was used to automate a number of insurance processes, such as policy management and claims processing. The routing of the claims to the appropriate adjusted are now automated and the status is tracked and reported to the concerned departments.

This helped the Insurance company to process claims more quickly and efficiently and reduce resources, resulting in major cost cutting.

Security:

Data privacy and security being high priority in insurance systems is handled effectively by the Customer Data Platform. Less human intervention has further led to a more streamlined and transparent system than before.

Conclusion

Agile Soft Systems, not only resolved all the client's problems, but also positioned them as a potential leader in their domain. Improving the Customer Experience has accelerated their business growth. The Health Insurance company has developed a deeper faith in our organization and are confident that their technology and systems can scale easily with their growth.

This case study is an example of how Agile Soft System builds and customizes software solutions to fit the clients' needs perfectly. Our Customer Centered approach to application development gives our clients the edge they need to compete in a highly competitive market of present times.