Reported impact
Business outcome
Elevance Health says the implementation makes healthcare journeys simpler and more personalized, gives members faster answers about benefits and care options, enables more proactive outreach, and gives associates more time to focus on empathetic member interactions. Internal research also indicates outreach texting improved participation in annual wellness visits, colorectal cancer screenings, and blood sugar control among identified members.
- Customer Experience
- Productivity Improvement
Solution
Elevance Health describes a multi-surface AI implementation focused on member navigation, proactive engagement, and associate assistance. In the Sydney Health app, the Virtual Assistant serves as the conversational front end, answering coverage, cost, deductible, and care-location questions for members and returning provider and pricing guidance for specific procedures. It works alongside an AI-driven provider search feature that helps match members to high-quality, lower-cost care. Separately, an AI-driven outreach program analyzes member context and care-gap signals to identify who should receive personalized reminders such as prescription refill prompts or annual wellness outreach. In service operations, a suite of AI tools supports associates with next-best-action suggestions, real-time claim-answering through a conversational chat interface, automated post-call summaries, and sentiment analysis across calls and chats. The source does not name the storage tier or external model providers.
Data flow
Member benefit, deductible, cost, provider-network, and claim-detail data are used by AI services exposed through the Sydney Health app and provider search to answer member questions. A separate outreach program evaluates member health context and care gaps to send personalized text prompts. In the contact center, call and chat interactions plus claim details feed associate tools for action suggestions, real-time answers, automated summaries, and sentiment analysis.
