OKM and Conversational AI

The path to digital relief in statutory health insurance customer service

Statutory health insurance companies (GKV) find themselves in a constant state of tension: insured persons expect excellent, seamless service across all channels, while the pressure to be cost-efficient and comply with strict regulatory requirements (keyword: data protection) is steadily increasing. As an IT service provider and management consultancy, we have observed that the contact centres of statutory health insurance providers in particular are reaching their limits. Increasing call volumes, complex enquiries and a shortage of qualified staff are leading to long waiting times, declining policyholder satisfaction and skyrocketing operating costs.

The challenge: the triangle of costs, volume and quality

The classic contact centre model in the statutory health insurance sector is facing systemic problems that urgently require a technological solution:

1. Rising call volumes and routine enquiries

A significant proportion of incoming calls – often over 60 per cent – concern recurring, easily automated standard processes (such as opening hours, range of services covered by the tariff, address changes, applying for a new health card, checking the status of a claim). These enquiries tie up valuable human resources.

2. High operating costs

Personnel-intensive service structures are expensive. The costs per interaction remain high, which is hardly sustainable in the context of statutory health insurance budgets. The potential for savings here lies not only in automation, but also in shifting services to more cost-effective digital channels.

3. Fragmented customer experience (omnichannel gap)

Although many statutory health insurance funds use different channels (telephone, email, apps or portals), these are often isolated from one another. Insured persons have to explain their history or their concerns anew each time they switch channels. This leads to frustration and an inefficient processing process.

The solution to this dilemma lies in the intelligent combination of omnichannel management (OKM) and conversational AI.

The strategic response: OKM and AI as dual drivers of efficiency

Omnichannel management (OKM) is not just about providing multiple channels, but seamlessly integrating these channels into a central service platform. This is where conversational AI (CAI) comes in, becoming the key lever for reducing costs and improving quality:

1. Smart volume automation through Conversational AI

• Chatbots and voicebots as first-level support: Intelligent bots can respond to standard enquiries fully automatically around the clock (24/7). Modern AI solutions understand not only keywords, but also the entire intent of the insured person.

  • Benefit: Immediate relief for the telephone system and a significant reduction in service costs per interaction. Waiting times for all insured persons are drastically reduced.

• Process automation and system integration: Successful bots are deeply integrated into the core systems of the statutory health insurance (e.g. oscare® environment). They can not only provide information, but also trigger transactional processes (e.g. updating data or sending documents).

2. The ‘augmented agent’ in the modern contact centre

Instead of replacing employees, modern contact centre technology makes GKV employees more efficient – we refer to this as the augmented agent.

• Unified agent desktop: Regardless of whether the insured person makes an enquiry by telephone, chat, post or email, the employee can see all interaction histories and necessary customer data on a single interface. This eliminates media breaks.
• AI-supported assistance: Conversational AI serves as a co-pilot for the agent. It provides suggested answers in real time, access to relevant knowledge databases, or automatically initiates the next steps in the processing procedure.

  • Benefit: The average handle time (AHT) for complex enquiries is reduced by more than 30 per cent and the quality of information increases, as all employees have access to consistent, verified knowledge.

3. Focus on compliance and data protection

In the statutory health insurance sector, the use of technology is inextricably linked to data protection (GDPR) and IT security. Our solutions ensure that all interactions and data processing meet strict German requirements. The technology enables precise auditing of every automated transaction.

Conclusion and outlook: The step towards digital health companions

The time for waiting and hesitation is over. Statutory health insurance companies that invest in a strategic OKM and conversational AI solution now will not only secure immediate cost savings and relieve the burden on their contact centres, but also position themselves as modern, digitally competent partners for their policyholders.