A major healthcare payer recognized the opportunities AI offered to drive operational efficiencies — but it valued its skilled trainers and did not want to remove them from the process of onboarding new healthcare advocates. A hybrid tech-human learning solution deployed with smart change management practices would put the payer on the right path, ensuring compliance and quality targets were met.

Challenge

Our client needed assurance and documentation that their newly hired telesales associates were properly trained and certified as licensed healthcare advocates assisting members with prescription drug plans and Medicare Advantage plans. The annual enrollment period was fast-approaching and a speedy, efficient ramp-up was essential.

The payer wanted to offload the time-consuming task of conducting mock calls with new hires, so trainers could focus instead on other, higher value work as coaches. The payer insisted its skilled trainers continued to oversee the certification process.

Our solution

TTEC’s Learning and Performance team deployed our AI-enhanced RealSkill solution that simulated interactions with members needing assistance enrolling in healthcare plans. We identified the top call drivers for licensed healthcare advocates and designed eight simulated conversations involving prescription drug plans and Medicare Advantage plans.

Our designers worked closely with subject matter experts, operations managers, and the quality analysis team to design 30- to 45-minute simulated conversations that played out under a variety of different scenarios.

To ensure smooth adoption, we crafted a change management strategy including job aids for both trainers and learners that covered navigation, troubleshooting, how to submit feedback, and summarize interactions. Our train-the-trainer program developed subject matter experts who then instructed fellow employees, an approach that assured institutional knowledge was preserved within the organization.

Following quality assurance guidelines from our client, TTEC designed exhaustive scorecards to evaluate performance across numerous activities such as collecting demographic data, verifying eligibility, and properly asking probing questions. Scorecards also covered setting expectations, effective communications, reviewing disclosures, and complying with HIPAA regulations.

Results

The program was developed and rolled out in just seven weeks, relieving 17 trainers of the time-consuming manual exercise of practicing calls with new hires.

Our client saved $210,000 annually by automating mock calls for new hires using TTEC’s AI-enhanced learning solution, a far less costly approach than role-playing with trainers.

The QA team evaluated the new simulations and rated them as accurate, comprehensive, and efficient as traditional, coach-led, role-playing exercises. 

Surveyed new hires awarded high marks for the hands-on practice experience and the training solution’s interactive functionality. Users’ overall satisfaction ranked 4.36 on a scale of 5, with 5 being excellent.