More customer satisfaction through faster responses

AI Factory: Two use cases

Digitalisation & Technology, 26.05.2021

Artificial Intelligence (AI) gains in importance and dynamism as soon as it can unleash its potential in business processes. At ERGO, it is already firmly anchored in some important areas. The technological basis for the targeted use of AI at ERGO is the AI Factory which //next has already portrayed. Two use cases exemplify its power.

More customer satisfaction through faster responses 

Acceleration in the reimbursement of outpatient medical bills

Nobody likes to wait. Especially not when money is involved. Anyone who submits an outpatient medical bill to ERGO expects to be reimbursed promptly. How can AI help speed up this process? The answer is: with the latest AI use case "Health Claims - Outpatient Medical Bills (HC-OMB)", developed on the basis of AI Factory. HC-OMB intervenes as a kind of "bouncer" when outpatient medical bills are received and independently decides which amounts can be paid out directly and when further checks or processing is necessary. To perform this service, HC-OMB had to "learn" which factors influence the decision. The fact that the AI experts in the AI Factory were able to realise the entire model training on the basis of ERGO's comprehensive treasure trove of data led to being able to make high-quality decisions both quantitatively and qualitatively. In order to additionally improve the prediction with further internal data material, information from previous benefit cases is also accessed during the invocation of the AI service. In terms of data protection and data security, the AI Factory offers everything necessary to be able to work with this highly sensitive personal health data.

The successful implementation at DKV Deutsche Krankenversicherung, which is part of the ERGO Group, also created a blueprint that could be implemented very quickly and easily in the very different IT and process landscape of the ERGO Group's second German health insurer, ERGO Krankenversicherung in Nuremberg, thanks to the AI Factory. This additional benefit is exemplary for the rapid adaptation of such solutions designed by AI Factory, which can unfold their effect in the most diverse places. "The AI Factory's powerful infrastructure enables us to efficiently develop AI solutions end-to-end. This includes data exploration and processing as well as AI model development, for example in the form of neural networks, and the subsequent productive implementation of these models," confirms Lucas Hafner, Data Scientist at ERGO Digital Ventures AG.

HC-OMB is considered exemplary for the integration of artificial intelligence into ERGO's core insurance systems and processes. "Our work focuses on the concrete benefits of AI for solving insurance-related issues," emphasises Alexander Haag, Senior Data Engineer at ERGO Digital Ventures AG and Business Lead of the AI Factory. There is also recognition from experts. Deloitte, one of the leading consultancies in the areas of audit & assurance, risk advisory, tax advisory, consulting and financial advisory, confirms the excellent and currently unprecedented technical "near real-time" integration into the process landscape in the ERGO host (mainframe) environment.

Precise forwarding of customer mails

Another example of the efficient use of AI in ERGO's business processes can be seen in the accurate allocation and forwarding of customer e-mails to the right person. Here, too, the positive customer experience generated by shorter response times is what counts. Not every e-mail that reaches ERGO is correctly addressed, which is not surprising given the large number of e-mail addresses. As a large group, complex structures have to be taken into account, which customers often disregard, and not without good reason. They rely on ERGO to forward their concerns to the responsible office as quickly as possible. Therefore, in order to avoid annoying time losses due to time-consuming manual actions and the risk of erroneous responses, especially for the customer, the AI Factory has developed the "Artificial Intelligence Classificator" (AIC).

For the ability of AI to understand texts, the AI Factory provides the possibility of using state-of-the-art neural networks. The underlying algorithm for text comprehension forms a "complete solution" in interaction with the email forwarding module also implemented in the AI Factory. AIC has to include a number of specific factors in the evaluation before an email is forwarded internally to the responsible department. For example, names, function designations, insurance numbers or formulations that consist of several elements and words.

Practice impressively proves the importance of AIC, which was also designed as a template for other areas of application in customer communication. After all, customer contact is not exclusively via e-mails. Letters, chats or telephone conversations that are recorded and transcribed also become solvable challenges with AIC.

Felix Wenzel, Head of Data Engineering at ERGO Digital Ventures AG and Business Owner of the AI Factory, also confirms that the bridge-building in the specialist departments is accompanied by positive feedback: "AIC is perceived in the specialist departments as a clear factor for relieving the workload, which is ultimately also rewarded by the customers. It gives ERGO employees room to concentrate on more value-adding tasks, which now also lead to shorter response times and greater customer satisfaction."

Exploiting all the potential of the digital "treasure trove" of data

The examples show that two significant prerequisites always lead to the success that the AI Factory drives: on the one hand, it is the interlocking and interaction of all people and groups involved in the processes, i.e. departments, developers and users. Secondly, it is the significant substantial digital data treasure, which is continuously growing, that the AI Factory can access. The digital "data culture" that is created in this way has the potential to add new facets to the customer experience.

Further information on the AI Factory can be found at

Text: Martin Sulkowsky

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