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About the company
Our client is a provider of healthcare cost containment techniques offering comprehensive consulting services, plan document drafting, subrogation and overpayment recovery, claim negotiation, plan defense, designed to control costs and protect plan assets.

Client Situation
Given the complexity of business and the vastness of historical data, our client had a non-searchable knowledge base and would expend considerable amount of time and effort to answer client queries for consultation purposes. The sheer volume of data and the lack of transparency into historical records meant exceedingly high turn around time for customer queries and tedious effort in terms of extraction, indexing, formation of answer and solving the query. This came in way of client’s target of providing exceptional customer service and thereby took a hit on their competitive advantage.


  • Querying an entire library of historical data affecting turn around time for customer issues – 1 week to 10 days to answer a customer query
  • Cross-departmental knowledge mapping and amalgamation causes dependencies and delays in formation of answers
  • No way of recording the queries that have been answered in the past- causing repeatability of task and wastage of man-power
  • Healthcare industry is subject to constant changes in terms of laws and legality – maintaining a dynamic database is effort heavy Solution took a solution-oriented approach, wherein we envisioned and co-created an intelligent, AI powered knowledge base (SoPhia), which acts as an IP-protected and interactive knowledge repository for the client. SoPhia acts as one source of truth as it has the ability to understand user queries using NPL technology, access the vast knowledge base of the organization including historical records in a jiffy, cross-verify the data and augment it with information needed from across department, index and present required answers in a comprehensible format.  Since SoPhia is an ML algorithm which is tailor made for the client and trained on the company’s rules and regulatory data, it generates responses aligned with the domain of the company and in accordance with the company’s guidelines. As a final step, human verification method was strategized to verify the responses in real-time and train the system to be independent.

What makes SoPhia a pioneering tool is its enterprise wide application through which the in-house client applications can interact with Sophia and answer queries/do tasks with minimal human supervision.’s AI/ML algorithm has advanced to have reasoning capability as well and acts as a true enterprise assistant.

 Why the approach works 

  • Strong understanding of Healthcare domain and claim issuance sector which helped in training the ML algorithm.
  • Extending capabilities beyond what has been asked for- making SoPhia liaise with internal applications to address end-to-end customer relationship management.
  • Hands-on approach by upskilling employees on how to use SoPhia and resolve issues arising with minimal supervision, nurturing independence, thereby striving towards our vision of democratizing AI.

Business Impact

  • Response to customer query reduced from 8-10 business days to 1 day
  • Increase in customer satisfaction score by 78% translating into business growth
  • Ensuring quality and consistency of information
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