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Upstream & Downstream Root Cause Analysis
Identify and address root causes with precision using detailed upstream and downstream analysis, unlocking actionable insights to drive process improvement.
Understanding Root Cause Analysis
AutoInsights enables organizations to go beyond surface-level metrics and uncover the underlying drivers behind key customer experience and operational outcomes. By combining AI-driven categorization, contextual analysis, and custom scoring logic, we help you distinguish between Upstream (business-controllable) and Downstream (agent-controllable) issues—allowing for faster resolution and long-term process improvements.
Upstream Issues
Problems originating from business processes, systems, or policies that are beyond agent control:
- Backlog in claims processing
- Unclear status updates in customer portal
- System auto-notifications sent in error
- Policy limitations
- Resource allocation issues
Downstream Issues
Problems resulting from agent actions or inactions during customer interactions:
- Agent failed to provide claim reference number
- Incorrect processing time provided
- Failure to explain next steps
- Inadequate problem resolution
- Poor communication skills
Case Study: Repeat Calls in Insurance Claims
The Problem
A large insurance provider observed a rising number of repeat calls regarding claims. Traditional reporting could identify high repeat rates but couldn’t explain why customers were calling back or what part of the process was failing—was it agent-related (Downstream) or a back-office/system issue (Upstream)?
The Solution
AutoInsights automatically analyzed transcripts of calls flagged as repeat interactions and segmented the findings into upstream and downstream root causes. Each cause was tagged, ranked by volume, and visualized to show trend lines by business unit.
32% of repeat calls were due to lack of clear claim status (Downstream)
41% were due to internal delays exceeding timelines (Upstream)
Root Cause Distribution
Repeat Call Rate Reduction
Customer Experience Impact
ROI Example: Insurance Claims Division
Pre-Analysis Metrics
Agents
0
Monthly Calls
10000
Repeat Call Rate
0
%
Accuracy
0
%
ROI Outcomes (Year 1)
Repeat Calls Reduced
0
%
Monthly Saving
100
Cost Per Call
$
0
Annual Savings
$
10
K
Post-Analysis Improvements
- Introduced proactive SMS status updates for claims in backlog
- Agent scripts updated to better manage customer expectations
- Identified top 3 process bottlenecks in internal claims workflow
CX Impact
CSAT Increase
0
pts
NPS Increase
0
pts
Why It Matters
Clarity on Accountability
Clearly separates agent performance gaps from systemic or process issues
Real-time Feedback
Output can be connected to agent dashboards or scorecards for instant feedback loops.
100% Call Coverage
Uncover issues hiding in the long tail of unreviewed conversations
Drives Intelligent Automation
Flags recurring issues that could be addressed through automation or deflection
Transform Your Customer Experience
Don't just measure what's going wrong—understand why. AutoInsights' root cause analysis brings intelligence and structure to operational reviews, helping teams reduce repeat calls, improve FCR, and transform how customer-facing processes are designed and managed.