Artificial Intelligence and Customer Service

A historical perspective on health plan customer service

I worked for 30 years in health care administration, mostly at Medica and United Health Group. Of that time, I worked directly in customer service about the first 15 years or so, and after that I worked along side customer service, but not directly in customer service. In a health plan, most service of health plan membership is via a call center.

I remember about 35 years ago being told that I needed to reduce my service staff, because the questions would all be answered with online tools. Of course that wasn’t true…it was a disconnect between what top management thought came in as questions and what questions actually came in. Management believed that customer service answered simple questions, but in reality the simple questions were few and far between and quickly dispatched. What took more time was complicated questions that needed some research and problem solving. Health care administration is anything but simple.

In order to provide resources to customer service staff, first we developed huge books (maybe 8 inches thick) we had on everyone’s desk to answer questions. Then, a decade later, the books were taken away and service staff researched questions on an Intranet. 

The equivalent of those huge book/Intranet will someday soon be available via chat, and there really will be a reduction in a need for staff. The staff that remain will need to solve problems rather than look up answers. The work will be more meaningful as the simpler questions are answered via chat. It will be more important than ever for staff to have critical thinking skills, since the “easy” questions will be resolved in chat.

I should add that in health care, the need for health care service disproportionately falls on an older population. What that means is that the reduction in the need for staff will happen gradually over time.

In the future, customer service reps will need to provide strong empathy and solve problems. Because of the simplicity of using AI to find answers, even if customers simply need help finding information, the information will be found in seconds rather than a few minutes. To prepare students for this future, instructors need to teach problem-solving and interpersonal skills. In addition, students need to know when the answers provided by AI don’t actually make sense (or seem equitable), and dive in to do some additional research. In the past, customer service reps needed “college or equivalent work experience”. Going forward, stronger problem-solving skills will be needed than in the past.

While there will eventually be a reduced need for customer service staff, the staff that remain will have even more meaningful work.