State-run health insurance marketplaces are acutely aware their technology is overdue for an overhaul. For many, the money simply isn’t there for modernization.

Intelligent IVR changes the equation and results are breaking 10-year performance records, without the cost and headache of a full infrastructure rebuild. TTEC provided a smart interactive voice response system and self-service functionality that enabled the contact center to meet or exceed every operational target during the critical peak season of open enrollment.

Challenge

Healthcare marketplaces, also called exchanges, run on razor-thin margins. Without deep pockets to fund infrastructure and operational improvements, processes are often inefficient and that harms the member journey.

Transforming the experience required the deep expertise and trusted knowledge TTEC brings to every engagement. Our understanding of how members navigate the healthcare system and where breakdowns occur enabled us to reduce misrouted calls that burdened healthcare advocates with inquiries outside their scope of work.

Diverse populations calling the contact center deserved seamless support but language capabilities and multichannel access was limited. Our knowledge of regulatory changes and evolving federal healthcare marketplaces allowed us to pinpoint where a lack of automation was creating friction — and engineer the right solutions to eliminate it.

All these challenges fell against a backdrop of the seasonal surge period, that narrow window of time when consumers must learn about healthcare insurance options, compare pricing, and select plans before open enrollment ends. 

Our solution

TTEC introduced a variety of operational enhancements and automation but the standout star was an intelligent IVR. The new IVR system improved routing and introduced a new self-service option for callers, providing easy access to tools, materials, and processes designed to make the enrollment process easier. Versatility and success of the new system was built upon four pillars:

Smart call deflection: The IVR identified incoming calls by intent and recognized those beyond the team’s scope of work, such as inquiries about premium payments or replacement cards handled by carriers. Such calls were routed directly to the correct channel instead of a live associate. Callers received answers faster and associates remained focused on enrollment.

Caller ID and priority routing: The system identified callers by name and captured their intents before connecting to a live associate. Putting this information at associates’ fingertips brought clarity to the interaction, reduced transfers, and prevented callers from having to repeat their reasons for calling.

Self-service: For simple and routine inquiries, such as resetting a password, the IVR system sent website links directly to callers’ phones, enabling them to complete tasks on their own. Links also enabled callers to start or resume enrollment applications and included helpful checklists of documents needed for enrollment. Once connected with an associate, callers were better prepared and had their paperwork handy, resulting in speedier calls.

Multilingual accessibility: The IVR system supported a dozen languages — English and Spanish plus 10 more of the most popular languages of the region. Full automation, not merely basic prompts, enabled callers to interact confidently with the system, in their preferred languages.

In tandem with the smart IVR, we updated information and improved access to ensure healthcare advocates had supporting materials at their fingertips when assisting callers. We introduced simulation-based training to improve associate readiness and streamlined escalation handling.

Results

Quality and efficiency gains were significant, achieving the best performance results in 10 years. During the critical open enrollment period, TTEC met or exceeded every operational target established by our client.

Nearly half (45%) of incoming calls were fully resolved within the new IVR channel. This reduced volume routed to live associates, enabling them to focus on their specialty: Processing enrollment applications.

Voice and chat service level performance exceeded previous years: 90% of incoming calls and chats received responses within 30 seconds. Abandon rates were consistently maintained below 5%.

Efficiency was not achieved at the expense of a quality experience. Our teams consistently maintained 95% CSAT, a best-in-class score far exceeding industry average CSAT scores of 78% to 85%.

TTEC’s ability to proactively introduce and operationalize IVR and automation aligned with the client’s strategic vision and goal to become a technology leader among state exchanges.

Our client wraps up each open enrollment period with formal lessons-learned sessions — a process to sharpen performance and address any missteps before the next cycle begins. The most recent session was exceptional by any measure. The highly trained and knowledgeable broker community was loudest with their accolades. KPIs told the same story: This was the program’s best enrollment period experience in 10 years.