Improving Member Experience through
Intelligent Self-service

A healthcare payer turned fragmented member support

into a more connected self-service experience powered

by AI-assisted guidance.

The Challenge

For a healthcare payer, rising member query volumes were exposing gaps in contact center operations. Disconnected systems made it difficult for agents to access information quickly, leading to delays, longer interactions, and inconsistent experiences.

High Handling Time
Agents spent longer resolving queries due to delayed access to relevant information
Extended Resolution Cycles
Significant time was spent searching, validating, and synthesizing data during interactions
Fragmented Workflows
Disconnected systems limited the ability to deliver consistent, first-contact resolution

The Transformation

To simplify interactions, the organization introduced an AI-enabled approach that brought together fragmented data and supported agents with real-time insights. This reduced effort during calls and improved response consistency.

Solution

Intelligent Information Retrieval
Enabled agents to quickly access and synthesize data from multiple systems
Automated Content Ingestion
Established a structured pipeline to ensure consistent and up-to-date information
Agent-assisted Self-service
Reduced effort during interactions while improving response speed and accuracy

30% reduction in handling time
Improved agent efficiency during member interactions
20% improvement in first-call resolution
Reduced repeat queries and follow-ups
30% improvement in member experience
Increased overall satisfaction across customer interactions