How to use Chatbot for Health Insurance: Complete Guide

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chatbot for health insurance

Last Updated: January 2025

“Chatbot for health insurance” refers to the innovative integration of artificial intelligence in the realm of healthcare coverage. These intelligent virtual assistants offer a streamlined and accessible means of obtaining information, filing claims, and navigating complex policy details. 

According to statistics, 74% of internet users have a preference for chatbots to find solutions for common queries. Thus, in this comprehensive guide, we’ll delve into the functionalities and benefits of utilizing chatbots in insurance, supported by real-world examples illustrating their practical applications.

What is an insurance chatbot?

Chatbots in insurance can be deployed to engage users in human-like conversations. These tools can provide round-the-clock support, streamline customer interactions, and improve customer satisfaction in the health insurance industry.

Chatbots for health insurance can be classified into two types: 

  • Rule-based chatbots: They operate within a predetermined framework of rules and are adept in managing FAQs or simple queries. However, they cannot learn and adapt from the interactions.
  • AI-powered chatbots: By harnessing the power of machine learning algorithms, these chatbots can efficiently manage complex customer inquiries. They have improved adaptability which allows them to manage intricate requests with more accuracy.

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Insurance chatbots benefits

The benefits of chatbots in insurance encompass various aspects, catering to both customer satisfaction and operational efficiency:

1) 24/7 Support

Chatbots offer round-the-clock assistance, ensuring customers can access information, receive quotes, and initiate claims at any time. This accessibility surpasses traditional call centers, which are typically limited to business hours. 

Moreover, chatbots aid customers in comparing plans and selecting optimal coverage through personalized recommendations, simplifying what can be a convoluted process.

2) More Meaningful Interactions

By handling routine inquiries and tasks, chatbots alleviate the burden on agents, allowing them to focus on more intricate issues. This can result in a significant reduction in phone calls, emails, and person-to-person chats. They enable agents to dedicate more time to high-value engagements that enhance customer interactions. 

Additionally, self-service channels provided by chatbots can enhance overall customer experiences by catering to dynamic interaction types.

3) Lower Operating Costs

With chatbots efficiently managing routine tasks, insurance companies experience notable reductions in operating expenses. By streamlining processes and increasing efficiency, chatbots enable smaller companies to operate effectively without the need for extensive employee hiring and training.

4) Lead Generation

Chatbots serve as automated lead generators, engaging visitors across various online platforms to collect pertinent information and answer queries. This data can be leveraged to nurture relationships and generate leads for sales teams, accelerating the customer acquisition process and enhancing prospect engagement.

5) Internal System Integration

AI-powered chatbots seamlessly integrate with insurance company core systems, CRM platforms, and workflow management tools. These robust integrations ensure a tailored customer experience, continuously updated with the latest details on products, services, and customer interactions.

6) Claims Processing and Settlement

Almost 44% of the customers think it is convenient to use chatbots for health insurance claims. Chatbots simplify the process of reporting incidents and manage the status of the claim settlements.

chatbot for health insurance

7) Multilingual Support

Human agents are limited by language proficiency but on the other hand, chatbots can easily provide support in multiple languages. This feature eliminates hiring additional support agents for global businesses with diverse linguistic needs.

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Use cases of chatbots for insurance

1) Answer FAQs and provide policy information.

Chatbots have the ability to interpret customer requests leading to a more effortless customer experience. Additionally, once a chatbot is linked to the company’s knowledge base, it can share more reliable information about the products and services. 

2) Suggest Policies and Onboard New Customers

Another great example of Insurance chatbot use cases is that these virtual assistants can efficiently guide customers and help them find the right policies that fit their needs. 

They can be deployed across multiple channels to provide a holistic customer experience without the need to jump from one channel to another.

3) Process and File Claims

With the help of a conversational AI insurance chatbot, the filing process can be sped up as it can gather information from multiple sources and operate round the clock for 24/7 support. Insurance chatbots can also help reduce phone calls and avoid unnecessary delays due to missing information. 

Furthermore, chatbots for insurance can proactively engage policyholders before, during or after any unfortunate incident to offer information and help on time. This helps to reduce the frequency and severity of loss while improving customer experience. 

4) Manage policies

A chatbot can streamline the entire policy management process when seamlessly integrated into your business toolkit. Customers can utilize it to apply for policies, update account details, switch policy types, request insurance cards, and more.

5) Advertising and Promotion

Marketing teams often leverage chatbots to bolster promotional campaigns and lead-generation efforts. Your insurance chatbot can disseminate information about discounts, promote whitepapers, and capture leads effectively.

Source: Whatfix

6) Collect Payments

Chatbots in insurance can also be used to facilitate easier payment process for existing customers. Additionally, if you have an app, the chatbot can send alerts and reminders with respect to upcoming payments. 

7) Gather Feedback and Build Loyalty

An insurance chatbot serves as an effective tool for collecting feedback from customers. Whether deploying a simple Net Promoter Score (NPS) survey or a detailed customer experience questionnaire, a chatbot attracts user attention and encourages more responses. 

Source: Whatfix

8) Cross-selling and Upselling

Beyond acquiring new customers, insurance chatbots excel in cross-selling and upselling strategies. By analyzing customer data, chatbots can recommend relevant offers based on the user’s current plan, demographics, or claims history, thereby boosting business profits without additional investment.

chatbot for health insurance
Source: Whatfix

9) Fraud Detection

AI-driven technology, including chatbots, is anticipated to play a significant role in fraud detection by 2030 according to McKinsey. However, you need not wait until then to leverage chatbots for fraud prevention. By integrating your chatbot with fraud detection software, AI can identify fraudulent activity early on, preventing unnecessary resource allocation towards processing and investigating fraudulent claims.

4 Examples of Insurance Chatbots!

1) Sensely

Sensley is a renowned chatbot for health insurance that helps plan members and patients access resources related to insurance whenever required. In 2019, Gartner named it “Cool Vendor” in the Healthcare and Artificial Intelligence niche. 

Additionally, now Sensely has evolved into a medical AI chatbot that can assess symptoms, do insurance underwriting, and offer pharmaceutical patient services programs. 

chatbot for health insurance
Source: Whatfix

2) SWICA

Another insurance chatbot example on our list is SWICA, a well-known health insurance provider, which has developed an advanced chatbot for customer support.

SWICA’s chatbot addresses FAQs and enables customers to make policy adjustments within the interface. Furthermore, customers can also update franchise details, addresses, request cards, add accident coverage or add family members through the chatbot window itself. 

Source: Whatfix

3) Insurify

Being the pioneer in insurance comparison websites, Insurify was also an early advocate for implementing chatbots in the insurance sector.

By using NLP and machine learning technologies, Insurify’s chatbot is adept in engaging visitors with several targeted questions to help them find the relevant policy. This chatbot operates within the Facebook Messenger App and can process text as well as images such as license plate pictures. 

chatbot for health insurance

4) Lemonade

The next insurance chatbot example is Maya – developed by a prominent insurance company named Lemonade. Driven by AI technology, the chatbot assists policyholders in applying for policies, making payments, filing claims, and sending updates on claim status. 

What’s more, Maya set a world record by processing and settling a $979 claim within 3 seconds!

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Source: Whatfix

Future of Chatbots in Health Insurance

Post the COVID-19 pandemic, customer’s preference for online interactions across various industries has increased and the insurance industry is no exception. While some insurance customers still prefer human contact, most of them favor chatbots to meet their needs swiftly.

Additionally, to match this trend and meet the demand of the customers, businesses have increased their investments in AI. According to McKinsey, 74% of executives are considering boosting their investment in AI in 2022. Consequently, it is anticipated that there will be a surge in opportunities for implementing AI-driven chatbots within the insurance industry.

Now that we have explored the use cases and examples of chatbots for health insurance, let’s explore Saufter – an AI-powered chatbot for proactive customer service!

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Meet Saufter – The best chatbot for proactive customer support!

Introducing Saufter – the AI-powered chatbot tailored for manufacturing to enhance proactive customer service. It autonomously learns and responds, accumulating a wealth of invaluable data.

Key Features

    • Rapid Knowledge Base Integration: Initiate training in just 2 minutes! Connect your knowledge base, and the Chatbot seamlessly learns from it.
    • Omni-Channel Delivery: Easily dispatch responses across web portals, emails, live chats, and social media platforms.
    • Usage Insights: Gain access to crucial statistics such as the most helpful, liked, and clicked content, optimizing your support resources.
    • E-commerce Expertise: Monitor orders round-the-clock, oversee returns, modifications, and delivery issues, and address changes seamlessly.
    • Integrated Channels: Enjoy the convenience of Saufter across multiple channels including email, live chat, phone calls, social media, WhatsApp, and SMS.

To Sum It Up

In conclusion, integrating chatbots into health insurance processes offers a myriad of benefits, from enhancing customer support to streamlining policy management and claims processing. 

Through real-world examples and comprehensive guidance, this complete guide has illuminated the transformative potential of chatbots in the realm of health insurance.

Remember, 62% of the people would rather use a chatbot than talk to a human agent as a chatbot can provide faster responses.

So take your time to note down your specific needs and choose the best chatbot for your business. However, if you need a chatbot to provide proactive customer support, explore Saufter. This AI-powered chatbot offers powerful automation features to free up your agents for more important tasks.

Sign up now for a 15-day free trial!

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