Case study
How a 400-person health insurer built its AI roadmap from every employee's voice.
The challenge
The leadership team knew AI should change how the company worked. Every department had a list of ideas, every vendor had a pitch, and nobody could say which change would matter most.
A consulting firm had proposed a twelve-week study built on a few dozen interviews. Leadership wanted something else: a view of how work really flowed across claims, member services and clinical review, built from the people who do it every day.
310
employees interviewed
1,400+
steps, waits and hand-offs mapped
6
bottlenecks scored and ranked
8
recommendations shaped by the team
The approach
- 01
Interviews
AI interviews ran in parallel across claims, member services, clinical review and provider relations. Each person answered by typing or by talking, when it suited them, and described their work step by step.
- 02
Map and bottlenecks
The interviews became one map of how the company operates. Six bottlenecks rose to the top, led by denied claims reworked by hand and prior authorizations that waited a median of 4.2 days.
- 03
Roadmap
Leadership shaped eight recommendations, each showing the process today and with AI, and chose where to start: reading every prior authorization request on arrival and sending complete ones straight to a nurse.
“For the first time, we could see how the company actually runs. We knew exactly where to start, and why.”
COO, regional health insurer
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