Fueling Momentum in Healthcare
When a national health plan provider faced overloaded call centers and rising operational costs during open enrollment, Pellera partnered with them to reimagine their member experience. By deploying a purpose-built AI agent, we delivered an innovative solution that reduced live human agent call volume by 20% while achieving an impressive 86% resolution rate.
The Challenge
For a national health plan provider, open enrollment brought a surge of member inquiries that quickly overwhelmed their support teams. Without a digital support option in place, members faced long wait times, leading to a strained and frustrating experience.
The organization struggled with rising operational costs and overloaded call centers. They needed to do more than simply reduce call volume; they needed to completely redefine how members engage with their services. They sought an always-on, digital-first support model that put people first, ensuring every member felt heard and supported during a critical time for their healthcare needs.
The Solution
The Pellera AI team collaborated closely with the health plan provider to bridge strategy and technology. We designed and deployed a specialized, intelligent AI agent seamlessly embedded into their existing service model.
By focusing on empowerment and seamless teamwork between human agents and technology, we implemented a comprehensive healthcare AI solution that:
01
Managed high-volume inquiries
The AI agent handled repetitive member inquiries, drastically reducing the workload on live agents and freeing them to focus on complex cases.
02
Automated quality assurance
We replaced manual QA reviews with automated, continuous monitoring and real-time performance reporting to ensure consistent service quality.
03
Enabled real-time escalation
Using advanced large language models, the system proactively detected toxic language and potential threats, allowing for immediate intervention.
04
Architected to support context-aware handoffs
The solution is designed to seamlessly transfer conversation history to live agents when human assistance is required. This approach preserves context, reduces repetition for members, and is expected to significantly improve the overall experience as capabilities are fully implemented.
The Results
Our collaborative approach delivered an unparalleled healthcare IT solution that drove immediate momentum for the client. The AI-powered service model achieved outstanding, quantifiable outcomes:
89% engagement rate
Members actively and successfully interacted with the new digital support tool.
88% containment rate
The vast majority of inquiries were handled entirely within the AI system without needing human intervention.
86% resolution rate
Member problems were consistently solved accurately and efficiently.
20% call reduction
Live human agents experienced a significant drop in call volume, alleviating burnout and improving overall operational efficiency.
Conclusion
By embracing a people-first technology approach, this national health plan provider successfully transformed a strained call center into a highly efficient, always-on support hub. The intelligent AI agent empowered live agents to work smarter while providing members with the fast, seamless support they deserve.
