Insurance operations leak value long before a claim is adjusted. The biggest drains live in non-claims work: contact centers (policy/billing/status), policy servicing, endorsements, agent/broker support, directory compliance, and third-party verification calls. The pattern is consistent: repeat contacts, after-call busywork, manual chase work, and waiting for internal responses.

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A few grounding facts:

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• Turnover is brutal: Contact centers average 30–45% annual attrition. Replacing agents is expensive and the quality drift is real. (TechRepublic)
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• Customers re-contact a lot: Average first contact resolution (FCR) across industries is ~69% — meaning ~31% of issues trigger at least one extra call. (SQM Group)
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• Calls are not short: Benchmarks put average handle time ~6 minutes (and insurance often runs longer). (Sprinklr)
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• ACW (after-call work) piles up: published ranges cluster around ~45–90 seconds per call (and can be minutes for complex billing). (VoiceSpin)
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• Insurance employs a lot of CSRs: BLS shows ~130k CSRs inside carriers and ~155k in agencies/brokerages (NAICS 524), with $22–$23/hr average wages — a large, ongoing spend. (Bureau of Labor Statistics)
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What that implies (illustrative math): If a CSR handles ~75 customers/day at ~6.1 min each, and 31% of those are repeat contacts (because FCR=69%), that’s ~2.36 hours/day burned on avoidable repeats — ~615 hours/year per agent. At typical insurance CSR wages, that’s ~$13.7k–$14.2k per seat per year just from repeat contacts — before any ACW reduction. (eCommons)

Add a realistic 50% cut to ACW (e.g., AI-filled notes/templates), and you can free another ~122–244 hours/agent/year (≈ $2.7k–$5.6k). (VoiceSpin)

1) Contact Center (Policy / Billing / Status)

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Wasted time drivers

• Repeat contacts because info lives in multiple systems or the first agent didn’t have authority/context (FCR avg ~69%). (SQM Group)
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• After-call work: note-taking, coding, disposition, letter/email drafting — often 45–90 sec per call and higher for complex billing. (VoiceSpin)
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• Talent churn → constant ramping, QA variability (attrition 30–45%). (TechRepublic)

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Why this matters economically

• There are hundreds of thousands of insurance CSRs across carriers and agencies; wages run ~$22–$23/hr. That’s billions in labor before tech, telephony, or vendor costs. (Bureau of Labor Statistics)

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Extra pressure points

• Healthcare contact centers report long hold times (e.g., 4.4 min avg vs. ~50 sec target) — a sign of structural mismatch between volume and staffing. (Dialog Health)

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2) Policy Servicing, Endorsements & Billing Ops

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Wasted time drivers

• Manual reconciliations and after-call documentation (same dynamics as above). (Sprinklr)
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• Underwriter/ops wait time: in agent/broker channels, >50% of producers still need live carrier help for quoting/checking status, and nearly half report >2 hours to hear back from underwriting — stalling sales and prompting repeat contacts. (glia.com)

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3) Agent/Broker Support Desk

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Wasted time drivers

• Producers ping carrier desks for underwriting clarifications, commission/licensing issues, or claim status when portals are incomplete. Over half still need live support frequently. (glia.com)

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4) Healthcare Plan Back-Office: Provider Directory Verification (NSA 90-day rule)

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Wasted time drivers

• Plans must verify directory entries every 90 days and update within 2 business days — recurring, clerical chase work. (Centers for Medicare & Medicaid Services)
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• Despite the rule, inaccuracies persist; one study found errors lingering 540+ days for ~40% of sampled providers — implying constant rework. (AJMC)
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Inputs (from research):

• Calls/agent/day: ~75 (Cornell) — varies by line. (eCommons)
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• Avg handle time (AHT): ~6–7 min typical; 6.1 used here. (Sprinklr)
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• FCR: ~69% (so 31% repeats). (SQM Group)
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• ACW: 45–90 sec per call (pre-automation). (VoiceSpin)
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• Wages: Insurance CSR ~$22–$23/hr. (Bureau of Labor Statistics)

Illustrative outputs (per seat/year):

• Repeat-contact waste: 0.31 × 75 × 6.1 min = ~2.36 hours/day → ~615 hours/year → ~$13.7k–$14.2k in labor. (SQM Group)
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• ACW reduction (50% cut): saves ~122–244 hours/year → ~$2.7k–$5.6k. (VoiceSpin)
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Takeaway: The “non-claims tax” in policy/billing/status work is five figures per agent per year in avoidable labor — even before considering attrition backfill, QA leakage, or dissatisfied members calling again.

• Siloed systems: Policy admin, billing, CRM, and claims notes don’t share context → agents ask customers to repeat themselves.
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• Human bandwidth limits: High churn (30–45%) keeps average tenure low, so knowledge resets often. (TechRepublic)
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• Unstructured work: Knowledge workers lose time to search/context-switching; McKinsey found 20–25% productivity upside from better collaboration/knowledge tooling — exactly the gap AI can close in service ops. (McKinsey & Company)

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• Agent/Broker support (quote status, underwriting Q&A, licensing/commissions): high frequency, repeat contacts. (glia.com)
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• Provider directory verification (NSA 90-day): constant attestations/updates with persistent errors. (Centers for Medicare & Medicaid Services)
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• Workers’ comp three-point contact (injured worker, employer, provider within 24–48h): many outbound calls, gatekeepers, and document chase. (Protective Insurance)

• AI answers and fills the forms; humans handle the tricky bits.
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  • AI does the first pass: ID verification, policy lookup, billing actions, status pulls, structured notes, and compliant scripts.
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  • Humans step in for edge cases (coverage gray areas, upset customers, complex billing disputes) and sign off on quality.
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• One-and-done design: Make it easy to solve on the first contact (FCR ↑), and auto-generate documents/updates so after-call work shrinks.
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AIBPO’s promise: We own the grunt work; you keep the decisions.

• We run agentic pods (AI + AIBPO human specialists) for Contact Center (Policy/Billing/Status), Agent/Broker Support, Provider Directory 90-day verification, and Third-Party Verification Calls (providers, employers, shops, vendors, other carriers).
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• Our AI handles: omnichannel intake, compliant scripts, system lookups, drafting notes/letters, call retries & follow-ups, and queueing tasks.
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• Our people handle: refusals/gatekeepers, ambiguous or multi-party issues, policy interpretation edge cases, and quality sign-off.
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• Our deliverable: an audit-ready packet (structured fields + artifacts) and updates pushed into your systems — so your team can make the final decision without rework.
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Why it pays back quickly (using the research above):

• Cut repeat contacts (close FCR gaps) and ACW at the same time → $16–20k/CSR/year in labor reclaimed is common in our models (based on FCR, AHT, ACW benchmarks and BLS wages). (SQM Group)
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• Attrition buffer: moving routine work to AI reduces stressors that drive 30–45% churn. (TechRepublic)
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• _{Attrition (30–45%): TechRepublic, SQM, Nextiva. (TechRepublic)}
• _{FCR average (~69%): SQM Group (2024–2025). (SQM Group)}
• _{AHT benchmarks (~6 min): Sprinklr round-up; Zendesk guidance. (Sprinklr)}
• _{ACW (45–90 sec typical; longer for complex): Voicespin; VCC; NICE. (VoiceSpin)}
• _{CSR employment & wages in insurance: BLS (NAICS 524: carriers & agencies/brokerages). (Bureau of Labor Statistics)}
• _{Agent/broker reliance on live help & slow UW response: Glia 2024 report. (glia.com)}
• _{NSA 90-day provider directory rule: CMS toolkits/FAQs; AMA summary. (Centers for Medicare & Medicaid Services)}
• _{Persistent directory inaccuracies despite the rule: AJMC study (2024). (AJMC)}
• _{Workers’ comp three-point contact standard: Carrier/TPA guidance (24–48h). (Protective Insurance)}

We’ll plug your FCR, AHT, ACW, volumes, and wage data into the same transparent model to project savings by month/line of business — then stand up a 6-week lighthouse (top 4–5 inquiry types) to prove it in production.