Beyond the Bot –
AI and Benefits

Artificial intelligence, AI has become part of our everyday lives. Whether we ask Alexa to play our favorite song or add soda to the grocery list… or ask Siri to set an alarm, we are used to turning to a virtual assistant. With SofiaSM, employees can ask for benefits help and get that help in seconds, too.

AI and Health Care

COVID has changed the game. Virtual health care. Virtual employees. Deferral of care. AI has renewed importance in our new normal.​ ​

The pandemic has illustrated AI’s strengths in data speed, work value, accuracy, and patient-centric care. For example, AI has infinite ability to retain and analyze data that can lead to improved care delivery.​ ​

Consider: 80% of employees in a recent survey believe virtual health will play a significant role in how care is delivered in the future—a sharp increase from 64% in 2019 and 52 % in 2018. (Source: 2021 Larger Employers’ Health Care Strategy and Plan Design Survey).  

The “Future” is Here

Artificial intelligence has come into the mainstream because it allows us to make sense of an increasingly large amount of data in real time. Indeed, worldwide data will grow 61% to 175 zettabytes by 2025. (Source: IDC)​ ​

In fact, 37% of organizations have implemented AI in some form. That means AI usage has almost tripled over the last four years and shows no sigsn of slowing down. (Source: Gartner)  ​

By 2021, 80% of emerging technologies will have AI foundations. (Source: Gartner) ​ ​

Sixty-three percent of people prefer to message a chat bot vs. talk with a human when communicating with a business. (Source: G2 Crowd)​ 

Employee Expectations and Needs

  • Employees today are increasingly tech-savvy.
    They expect lightning-fast answers to complex questions and expect them in “Google-like” fashion—right now. They also want answers in their time of need, whether it’s a late-night visit to the ER or researching coverage for maternity care. Having a benefits assistant is a must, especially as regulations, plans and coverage are in a constant state of flux. ​ 

  • Employees today are increasingly benefits-illiterate.
    While many may live with their phones inhand, some don’t know the word “deductible” from “copay.” They need a way to get answers without constantly calling their employer, they need help understanding what they’re enrolling in and they need to know how to activate the benefits they elect. Our mid-year enrollment report in 2020 revealed that 39% of employees indicated they were confused about their benefits… with newcomers to the working world (Gen Z) coming in at a whopping 61% confusion rate. 

Benefits Team Needs

  • More resources. 
    Most HR teams would tell you they need at least one more set of hands to get their jobs done in a given day. With many companies trying to accomplish MORE with fewer resources, answering basic and detailed benefits questions is a task they’d happily outsource if possible.​ 

  • Ways to address diverse accessibility needs. 
    More than 15% of the adult population in America speaks a language other than English at home (US Census). Many are bilingual, but imagine trying to understand benefits in a language other than your native tongue. In a world where diversity and inclusion has never been more important, employers need to allow people of all different cultures and abilities to engage.​ 

  • Simple and accessible technology. 
    Benefits teams shouldn't need an IT degree to get their population enrolled and engaged. With the easy-to-use technology and embedded AI solution in Benefitsolver®, enrollment, decision support and engaging the workforce becomes a streamlined function to free up team members for the harder stuff. 

Sofia could be the hardest working member of your team

An intelligent application, Sofia is Benefitsolver’s personal benefits assistant. She’s on call 24/7. Her ability to direct employees where they need to go, armed with the information they are seeking, takes pressure off employees in becoming benefits experts while providing a hyper-personalized experience. She also diverts traffic from the benefits team by answering health plan, consumer-directed accounts and voluntary benefits questions. 

​At her core, Sofia is a technology built to create a more meaningful and efficient benefits experience, one that allows employers to better engage their employees in all the benefits programs and services offered. ​ ​

Whether an employee is looking for information about their benefits or trying to understand what an upcoming surgery may bring, Sofia is their guide in finding the information they need that will lead to better outcomes.  

Staying Ahead of the Questions

Benefits are always changing. Between legislative regulations and health plan changes year over year, it’s hard for one person or even the team to stay on top of it all and access the right answers in a timely way. Likewise, a standard chatbot programmed with “Yes/No” or FAQ-type answers isn’t going to be much help either. Sofia is programmed continuously and learns from her interactions. Through a systematic feedback loop and dedicated machine learning engineers, Sofia acquires new understanding of user intent and benefits information. 

Our data science team, responsible for her development and training, has a direct line of sight to our member services team, so Sofia undergoes the same training that we expect of our member advocates. She learns from training sets as well as from her interactions with employees themselves. If we see a trend with hot topics or an escalated number of calls coming into the Service Center, we quickly equip Sofia with the background and tools she needs to handle those participant questions without delay. (She learned lots of information related to COVID-19 in a few short weeks!) 

Unique roles supporting unique functions

AI is a multidisciplinary field consisting of a deep understanding of math, computer science, linguistics, psychology and the business domain you operate in. 

So, in addition to the traditional product team members, we have other notable roles on our team:

Research Scientists 

Research Scientists, whose responsibility is to test out new ideas, design experiments, build models and keep us at the forefront of our field.

Machine Learning Engineers 

Machine learning engineers work closely with our product and software engineering teams to convert our research ideas into production-ready applications.

Computational Linguists 

Computational linguists who help Sofia understand the nuances of language and how to handle them. Since Sofia is capable of operating in 28 languages, the problem space extends past English.

Software Engineers

Software engineers use the latest technology to build new features and improve existing components for Sofia.

Product Managers

Product managers look to understand, first and foremost, our customers, then our industry, marketplace, and our AI capabilities so that they can represent the customers' voice when making decisions on Sofia's development. 

Real-World AI in Action

Sofia delivers real results as a member of each of our client’s teams. During our most recent annual enrollment period, she successfully resolved 87% of her total chat volume, including 31% of those chats on nights and weekends. Most often, she’s handling questions about dependent verification, ID cards, enrollment confirmation and FSAs. Millennials are the most enthusiastic about turning to Sofia for help with 43% of her interactions coming from that demographic. However, she is available for everyone, as 34% of Gen Xers and 22% of Boomers also found answers with her help. See those full stats here. 

Extra Credit Reading

Two members of our Sofia team wrote a research paper about how Sofia is trained to understand sentiment analysis through our member services call center. It's a deep dive into Sofia's world of natural language processing and machine learning.


To see Sofia in action and her capabilities, schedule a demo with our team today. 

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