Overview
One of the leading life insurance providers in Southeast Europe, a well-established company with a strong reputation for innovation and customer service, sought to enhance its health insurance offerings. Serving hundreds of thousands of individual and corporate clients, the company is part of a major European financial group and prides itself on comprehensive insurance products tailored to modern customer needs. Recognizing evolving digital expectations, the insurer collaborated with Sirma to implement an advanced AI assistant to revolutionize customer engagement and operational efficiency.
The Challenge
The insurer faced growing customer demand for instant, digital access to health insurance services such as policy management, appointment scheduling, and reimbursement requests. Legacy support channels like telephone and email proved inadequate, slow to respond, costly to operate, and unable to scale with rising inquiry volumes. The existing systems could neither support 24/7 availability nor deliver a personalized, user-friendly experience, resulting in customer frustration and operational inefficiencies. The company needed a fast, secure, multilingual, and intuitive digital solution fully integrated with backend systems to offer real-time, automated customer service and reduce manual support burdens.
The Project Scope
Key objectives encompassed:
- Designing and deploying a secure AI-powered chatbot accessible via the insurer’s digital service portals;
- Enabling multilingual support to serve a diverse customer base
- Covering critical self-service functions, including purchasing insurance products, scheduling medical appointments, submitting claims, reviewing coverage, retrieving policy details, and accessing virtual health cards
- Complying rigorously with local healthcare regulations and data protection laws;
- Integrating deeply with backend systems for real-time data exchange and process automation;
- Ensuring scalable architecture capable of handling peak demand and continuous learning.
The Solution
Sirma developed a sophisticated conversational AI assistant leveraging state-of-the-art natural language processing (NLP) and machine learning techniques. The assistant was embedded directly within the insurer’s digital portals, offering intuitive 24/7 self-service capabilities. It smoothly handles diverse customer requests, from complex claim submissions to quick policy inquiries, without human intervention. Rigorous compliance considerations shaped the system design, incorporating data privacy safeguards and multilingual capabilities.
Real-time backend system integration was pivotal, allowing the assistant to fetch and update policy statuses, claim information, appointment schedules, and coverage details dynamically. This ensured responses were accurate, timely, and personalized. Additionally, the system continuously learns from customer interactions to improve intent recognition and service quality further.
Results
- Over 85% of customer queries are now resolved without human intervention, dramatically reducing reliance on call centers;
- Call center volume decreased significantly, lowering operational costs and improving resource allocation;
- Customer satisfaction improved markedly due to instant, reliable 24/7 service availability;
- The insurer positioned itself as a leader in digital transformation within the regional insurance market;
- The project garnered positive national attention and industry recognition for innovation in service delivery.
Digital Transformation Manager, Life Insurance Company:
The AI assistant turned out to be more than just a chatbot—it’s our digital face to clients. It made health insurance easier, faster, and more accessible.
Technologies
- Advanced NLP and machine learning models specializing in healthcare-specific language and intents;
- Multilingual conversational AI frameworks enabling natural, seamless interactions across language barriers;
- Secure API integrations with insurer backend systems including policy management, claims processing, appointment booking, and health card access;
- Compliance frameworks ensuring GDPR, health data protection regulations, and local legal adherence;
- Scalable cloud infrastructure supporting continuous learning, high availability, and peak demand management.
Sirma’s Relationship with Client
Sirma worked closely with the insurer throughout the project lifecycle - from design and development to deployment and ongoing refinement. The partnership emphasized understanding the client’s compliance, operational, and customer experience goals to tailor AI capabilities precisely. Sirma provided dedicated expert teams for integration, multilingual training, and continuous performance monitoring. Through transparent collaboration and agile development, Sirma enabled the client to accelerate digital transformation securely and effectively. The client continues to collaborate with Sirma to expand AI-driven capabilities across insurance operations, reinforcing long-term innovation and competitiveness.
