Some call centers have an easy time – the customer information can be extracted from a database and shown on a screen, or there is a single defining document that applies to all callers – the tax law – so it is worth going into great detail to spell out every nuance.

Some call centers have a much more difficult time – knowledge about the relation between the organization and the customer is held in text, and it can be anywhere from subtly to dramatically different for different callers. We will use health Insurance as an example. The call center operator has to answer questions and make decisions based on a lengthy and rather impenetrable document – guessing or using a previous answer to another caller could be an expensive mistake. We are proposing a semantic factory approach to this problem – the machine can answer questions based on the contents of the document.

Semantic Factory

It would take too long (at least several hours) for a machine to read one of these documents. An alternative approach is to read the document beforehand – to have a fleet of machines reading documents, and creating the semantic structure for each document in the form of a memory image. The images are stored in parallel with the documents.

Call Handling

For a new call, the caller is identified and the specific memory image is loaded. A database access is used to update the semantic structure – the caller is up to date on payments, the term for a pre-existing condition has expired, the current out-of-pocket amount, etc. The caller speaks to the operator, and the operator enters questions in free text. The machine analyses each question, taking into account terms defined in the document and the contents of other documents, such as pre-authorisation lists, and returns the appropriate answer. Questions can take the form of discovering context, choosing between objects, logical states (Yes/No) and providing values (all the necessary pre-requisite steps would be checked before providing a value). Some examples:

• Where does it say that prolotherapy is not covered?
• Is this the secondary plan?
• Is cruciate ligature repair covered?
• My daughter needs a heart operation costing $42,000. How much will the out-of-pocket be?

At the end of the call, there may be information that can be used to update the database (in the form of notes the machine can read next time they call, or check against when bills come in), and then the memory image is overwritten by a new image for the next caller.

Giving the call center operator the ability to ask questions of the machine reduces the stressfulness of the operator’s job and reduces the number of mistakes. It is only a small step from this level of sophistication to providing a web-based tool to answer customer’s or provider’s questions automatically.

Presentation – Call Center Support