Deflection Results
Measured in production. 23% of all calls now resolve without a person, and the share is climbing.
Of the claims the system can see, six in ten resolve without a person. Data access sets the ~86% ceiling. One eligibility endpoint covers a third of all denials and is on the client's roadmap.
*The client's engineering team shipped the live claims API during the engagement; each new endpoint raises the resolution ceiling.
At a Glance
Modeled from the claims team's loaded cost and 3,000+ claim inquiries a month at full deflection; a conservative estimate, not a client-reported figure. Deflection itself is measured in production on every call.
Change Since Kickoff
- W4Every call answered
- W6Live claim lookup ships
- W10Appeals filed on the line
- W1423% of all calls
- Calls answered1 in 4Every call3,000+ claim inquiries a month
- Claim statusVoicemail, then a callbackRead back in secondsLive API lookup
- AppealsA separate processFiled on the callIDs written to the case
Maintenance Scope
Workflow Tuning
Prompts, decision logic, and policy scripts refined weekly from real call reviews. The system gets better because someone is watching.
Endpoint Upgrades
As the client's platform team ships new data endpoints, we wire workflows onto them. The eligibility endpoint alone moves a third of denial calls to on-line resolution.
New Workflows
A denial-response flow is in UAT now. The email queue is scoped next. Half a person handles its thousands of messages a month.
Operating Cadence
Working session with the client's claims and engineering leads; UAT on every workflow change; call reviews.
Deflection trajectory against the ceiling; roadmap re-prioritized by measured call volume and endpoint availability.
Getting Started
Call data in and a sized build plan out. The first workflow takes production traffic within a month.