We developed and deployed the AI voice agent in three phases over 16 weeks. Phase 1 (weeks 1-5): membership enquiry agent. The first voice agent handled the highest-volume call type: membership enquiries. Architecture: the caller is greeted by the AI agent ("Hello, this is your health fund's virtual assistant. I can help with membership enquiries, claims, finding providers, and payments. How can I help you today?"). The AI agent authenticates the caller using: member number (spoken or entered via keypad), date of birth, and Medicare number — matching the existing human authentication protocol. Once authenticated, the agent has real-time access to the member's policy data through API integration with the health fund's core membership system. The agent handles: coverage enquiries ("Am I covered for dental?
" — the agent checks the member's specific product and responds with their actual coverage details, excesses, and any waiting periods), benefit utilisation ("How much of my dental benefit have I used this year?" — the agent checks the member's claims history and reports remaining benefits), waiting period status ("When does my waiting period for major dental end?" — the agent calculates and reports the specific date), and product comparison ("What would I be covered for if I upgraded to the next level?" — the agent compares the member's current product with the upgrade option and highlights differences). Phase 2 (weeks 4-10): claims status and provider search. Claims status agent: members call asking about claims they have submitted.
The AI agent: looks up recent claims (by date range, provider name, or claim type), reports claim status (received, being assessed, approved, paid — with dates and amounts), explains any claim rejections (with the specific reason — waiting period, annual limit reached, service not covered under their product, provider gap), and initiates claims reviews when the member disagrees with a decision (collecting the member's reasons and routing to the claims review team). Provider search agent: members call to find preferred providers before treatment. The AI agent: searches the provider network by: location (near the member's registered address, near a specific suburb, or near their current location), specialty (dentist, physiotherapist, optometrist, psychologist, etc.), and gap status (no-gap providers where the member pays nothing above their excess, known-gap providers with predictable out-of-pocket costs).
The agent provides: provider name, address, phone number, and whether the provider offers direct billing (the member pays nothing at the point of service — the provider bills the fund directly). Phase 3 (weeks 8-16): payment management and full deployment. Payment agent: handles direct debit updates (new bank account or credit card details — with PCI DSS tokenisation of card numbers), payment frequency changes (weekly, fortnightly, monthly, quarterly, annual), payment holiday requests (temporary suspension of cover and payments — with clear explanation of the implications for waiting periods and coverage gaps), and arrears management (members behind on payments — AI explains the situation, offers catch-up payment plans, and processes immediate payments). Full deployment: all four agent capabilities deployed behind a single entry point.
The AI understands multi-intent requests ("I want to check if I am covered for physio, find a physio near work, and also update my direct debit details") and handles them sequentially within a single conversation. Escalation to human agents for: complex complaints, hardship applications, policy cancellation (retention team), and any request where the member explicitly asks for a human ("I want to speak to a person" — immediate transfer with conversation summary). Voice characteristics: the TTS voice was selected in consultation with the health fund's brand team — a warm, professional Australian female voice at a slightly slower pace than standard (recognising that many callers, particularly elderly members on hospital cover, appreciate a measured speaking pace). The AI adjusts: speaking more slowly when explaining complex coverage details, pausing to let the member process information, and offering to repeat or explain in simpler terms when it detects confusion.