- Using AI, UnitedHealthcare customer care advocates can connect with members on a more personal level.
- AI tools make care navigation more personalized, efficient, and human.
- UnitedHealthcare's strategy ensures AI enables and supports, but never replaces, critical human decision-making.
At some point in their healthcare journey, many Americans will turn to a call center advocate working for their health insurance company when they have questions or need support navigating their next steps.
On the other end of the line sits someone who must do more than process benefits or look up a claim. They often guide people through some of the most personal and stressful moments of their lives. It's a job that relies on empathy, and increasingly, on technology that allows that empathy to flourish.
Inside UnitedHealthcare's customer care centers, an ambient AI assistant captures the conversations, providing member information and handling routine administrative tasks so employees can focus on the individual, not paperwork. The system, known as Advocate Assist, is one of a suite of AI tools the insurer has developed to make care navigation more personalized, efficient, and human.
"In retail, finance, or travel, digitalization is about clarity and informed decision-making," said Mike Baker, UnitedHealthcare's chief operating officer. "Those things matter in healthcare, too, but they're not enough. What sets this industry apart is compassion, and technology has to amplify that."
Guiding principles
With each new wave of automation, as digital platforms and AI take on more responsibility for simple tasks, companies must work to preserve the human connection. In healthcare, where interactions are often sensitive and deeply personal, the need for that human connection is amplified. The challenge facing stakeholders in the healthcare system isn't simply to embrace technology, but to do so without hollowing out the humanity that gives the work its meaning in the first place.
That's why, Baker said, UnitedHealthcare's AI strategy was anchored early on in several core concepts designed to keep people, not algorithms, at the center of care.
- The first two core concepts are reliability and quality: Any system must be transparent and intelligible, fair, and something people can understand and trust.
- Next is accountability, with technology developed and deployed under the guidance and oversight of UHG's Responsible AI Program and in compliance with responsible AI frameworks. Those frameworks establish clear guardrails for the technology's use, putting privacy and security at the center while maintaining a focus on continuous improvement.
- Lastly, and crucially, AI must be used safely and responsibly to enable and support — but not replace — critical human decision-making. Clinical medical decisions always rest with licensed professionals; the technology's role is to surface options, prompt questions, and streamline the background work so clinicians can focus on care.
From theory to practice
Rooted in these cornerstone principles, UnitedHealthcare's new AI initiative aims to provide members with clearer ways to navigate their health plans and the healthcare system with greater confidence.
Two of the digital platform's newest features, Members Like You and Smart Choice, are central to this ambition.
The former draws on patterns from millions of UnitedHealthcare members' healthcare journeys to flag the care options that others in similar situations have explored. If an expecting mother searches for obstetric care, for example, the system may highlight services that other soon-to-be moms have turned to — things like prenatal classes, behavioral health support, and postpartum resources.
Smart Choice approaches transparency from a different angle. Rather than presenting people with a basic list of providers, it allows them to search according to practical factors such as cost, distance, the provider's spoken language, or appointment type — the everyday details that often shape real decisions. As Baker puts it, "there's no choice that isn't made better by data and information."
That focus on usability seems to be resonating. Last year, UnitedHealthcare recorded more than 100 million digital visits to its member portal and app, with a majority of members (60%) now turning to the latter to search for care providers or manage their benefits.
Always inclusive
Of course, a digital format isn't for everyone. Baker acknowledges that some people will always prefer a human voice when they have a question — his own 84-year-old mother among them. Call centers staffed by people, supported by AI, will ensure that no one is left out as technology advances.
That inclusivity is central to how UnitedHealthcare sees its digital platforms developing in the years ahead. After considering millions of its members' everyday interactions with the health care system, the company might refine its services to adapt as habits and expectations shift. It's a way of ensuring the system evolves in response to real behavior, not top-down assumptions.
And though the company is ready to pivot as new technologies emerge, Baker insists it will never lose sight of the person at the center of the experience. "Our strategy has been, and will continue to be, grounded in the principle of personal, human healthcare," he said.
Learn how UnitedHealthcare is using technology to make every healthcare experience more personal.
This post was created by Insider Studios with UnitedHealthcare.
-->
The post Technology is transforming how patients navigate the healthcare system, and compassion remains the anchor appeared first on Business Insider