Smart Health Dental: AI Voice Agent for Insurance Verification
An AI-powered voice system that handles compliant verification, enrollment confirmation, and customer service interactions across Smart Health Dental's dental and vision plans.
The Challenge
Smart Health Dental required strict post-enrollment verification calls for their dental and vision plan offerings, including Dental Discount, PPO, MAX, Elevate, and Vision add-on products. Each verification call needed to execute legally required scripts verbatim, confirm identity, plan selection, pricing, and payment authorization, while reading state-specific fraud disclosures. Manual execution by human agents created risk of script deviation, inconsistent disclosure delivery, and compliance exposure.
Customer service workflows for enrollment status, plan confirmation, and billing questions required consistent execution of approved language across all interactions. Scaling these verification and support operations meant adding headcount, while compliance audits demanded reliable documentation. The organization needed a solution that could handle both outbound verification and inbound support calls while maintaining compliance standards and operational consistency.
Our Approach
We deployed a script-driven AI voice agent system that executes compliant verification workflows and handles customer service interactions across Smart Health Dental's plan portfolio.
Implementation Phases
Compliance requirements, script documentation, plan workflow mapping
Voice flow development, enrollment system integration, compliance testing
Limited deployment, script refinement, coordinator escalation testing
Production rollout, monitoring configuration, audit trail validation
System Architecture
Enrollment data, plan selection, billing details
AI voice execution of compliant scripts, conditional plan logic, consent capture
Verification status, compliance-ready call logs, routed service interactions
All calls recorded and encrypted; routes to Elite Care Coordinators when human assistance required.
Backend Architecture
Secure CRM Integration
The AI voice agent integrates with Smart Health Dental's CRM and enrollment systems via authenticated APIs. Enrollment data is securely retrieved at call start and scoped to only the fields required for verification and support workflows.
Call Context & Flow Logic
- Short-lived, in-memory call context per interaction
- Dynamic script population using live enrollment data
- Conditional logic by plan type, billing method, and state
- Multi-step verification continuity without persistent storage
Script Execution & Compliance Control
Verification and customer service flows are executed using deterministic, script-driven logic. Required disclosures are delivered verbatim, while branching paths adapt to the customer's plan configuration and responses.
CRM Updates & Audit Logging
- Verification and consent status written back to CRM
- Call disposition and escalation flags recorded
- Secure linkage to call recordings
- Compliance-ready audit trail per interaction
Security & Data Handling
- Encrypted API communication
- Scoped and rotated credentials
- Ephemeral handling of sensitive data
- Controlled escalation to human coordinators
Results & Impact
Verbatim script delivery across all plan types
Handles verification and support without additional staffing
Uniform interactions across enrollment and service workflows