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success story

How AI transformed call cycles and CX for a healthcare payer

A leading US healthcare payer partnered with Virtusa to modernize its customer service operations with a genAI-powered Contact Center AI (CCAI) Agent Assist solution. The engagement reduced call handling times, improved resolution rates, and delivered faster, more accurate service across voice and chat channels, all at scale and with compliance.

KEY SERVICES

Voice bot and chatbot design using Dialogflow CX
CCAI Agent Assist and CCAI insights implementation
Multi-channel (voice and chat) integration with real-time context sharing
AI-powered intent detection, routing, and agent assist
Compliance-focused call recording and audit support
Continuous model improvement with manual overrides and feedback loops
Key technologies/platforms
Google Cloud Contact Center AI (CCAI) Agent Assist
CCAI Insights
Dialogflow CX
Retrieval-Augmented Generation (RAG) backend
GenAI models for intent detection and response generation
Real-time analytics dashboards for performance, sentiment, and compliance tracking

The need for speed and scale

The US-based healthcare payer handles thousands of customer and provider calls every day, addressing critical questions related to eligibility, benefits, prior authorizations, and claims. However, the contact center struggled to maintain service standards as call volumes increased.

Agents relied on multiple, disconnected systems to retrieve information during live calls. Navigating databases, policy documents, and internal portals led to long resolution times, high handle durations, and increased agent fatigue.

Without a centralized, intelligent support layer, even routine inquiries required effort and judgment, leaving less time for complex cases. Inaccurate or delayed responses posed financial risks to both the payer and its customers, especially when tied to time-sensitive care or claims decisions.

The lack of automation, real-time context, and unified access created avoidable delays, inconsistent service quality, and rising operational costs. The payer needed a solution that could reduce the burden on agents, improve speed and accuracy, and scale effectively across contact channels.

That’s where Virtusa stepped in, transforming these challenges into an opportunity for a smarter, faster, and more human-centric support experience.

AI-powered contact center transformation with real-time support

Virtusa approached the challenge of improving customer service quality and operational efficiency by embedding AI across the contact center environment. Working closely with the client’s contact center and technology teams, Virtusa identified the highest-impact use cases and developed a scalable solution powered by Google’s Contact Center AI (CCAI) Agent Assist and CCAI Insights. By integrating conversational AI, Retrieval-Augmented Generation (RAG), and real-time analytics, the system operated across voice and chat channels, surfaced relevant information during live interactions, and continuously improved through real-time feedback and performance analytics.

Key features include:

Automated voice and chat handling: Dialogflow CX powered virtual agents that detected user intent and handled high-volume provider inquiries, reducing agent workload and improving response consistency.
Retrieval-augmented generation (RAG) integration: The system retrieved contextual data from backend sources in real-time, allowing AI-generated responses to remain relevant and accurate.
Real-time agent assist: On-screen guidance helped agents respond more effectively during live calls. Manual overrides and feedback options enabled ongoing model improvement.
Pre-call and post-call summaries: Before each interaction, agents were provided with the caller context. Post-call documentation was auto-generated to support audit readiness and training.
Analytics and insight dashboards: The platform tracked key metrics, including call trends, resolution times, sentiment, and compliance. This gave teams the visibility needed to drive continuous improvement.

Measurable impact across operations, experience, and compliance

Operational excellence
- Automated high-volume intents, freeing agents to focus on complex needs
- Achieved 95% solution accuracy with minimal latency (5–7 seconds)
- Reduced agent workload and improved response efficiency
Superior customer experience
- Faster, more accurate issue resolution reduced wait times and improved first-call resolution rates
Data-driven decision-making
- Real-time insights and trend analysis to optimize contact center performance
- Comprehensive compliance, audit, and training support through detailed call documentation

Why Virtusa?

The client chose Virtusa for its deep healthcare expertise, proven delivery capabilities, and trusted partnership with Google Cloud. From solution design to deployment, Virtusa aligned technology to operational goals—enabling speed, accuracy, and compliance without adding complexity.

Virtusa believes in engineering what matters. For this healthcare payer, that meant capturing context early, assisting agents in real time, and delivering actionable insights that continuously improve the experience. The result is faster, smarter, and more human-centric customer services that scale with confidence.

Business impact

Achieving high accuracy with near-instant response times has significantly enhanced decision-making and elevated the customer experience. It enables faster, more reliable, data-driven interactions, improving operational efficiency and customer satisfaction.