AI Voice Agent – Insurance Eligibility Verification
Smart Health Dental deploys autonomous AI voice agents for insurance verification, reducing handle time by 65% and reclaiming 160+ agent hours monthly.
The Challenge
Smart Health Dental's agents were spending 70% of their day on hold with insurance carriers for basic eligibility checks. This created long turnaround times, backlog during peak hours, and high operational cost per verification.
The repetitive nature of verification calls was draining agent morale and limiting their availability for complex cases that required human judgment. The company needed a solution that could handle routine verifications autonomously while escalating exceptions.
Our Approach
We deployed fully autonomous AI voice agents capable of navigating carrier IVR menus, completing routine verifications, capturing results, and syncing data into their CRM. Agents escalate complex cases and handle real-time handoffs.
Implementation Phases
Mapped IVR flows for major carriers, designed conversation logic, built fallback patterns.
Integrated Retell AI, configured Twilio SIP trunking, implemented verification workflows.
Connected TLD and Admin123 CRMs, automated data sync, built result logging.
Conducted HIPAA compliance review, tested edge cases, deployed to production.
System Architecture
Caller request, carrier info, member details
Voice agent reasoning, IVR traversal, verification retrieval
Eligibility result, CRM update, optional handoff
Results & Impact
Reduction in average handle time per verification
Routine verifications completed without human intervention
Agent hours per month redirected to complex cases