success story

Virtusa empowers major payer's contact center transformation with domain consulting powered by cutting-edge technology

Virtusa empowered major payer's contact center transformation resulting in platform and process unification with Triple R Methodology while improving customer and agent experience using Voice-AI.

In today’s digital world, customers expect high-quality, consistent customer service from their healthcare insurance providers and expect CSRs to understand their customers and the purpose of the call.

Steering through challenges

Our client, one of the leading healthcare payers in the United States, encountered a process and application issue, impacting the average handle time, leading to dissatisfaction among customers and hindering critical business services. This resulted in long wait times, manual processes, reduced customer engagement, increased costs, and decreased productivity. Additionally, the client was facing challenges of having inconsistent and complex UI in place leading to extra efforts to accomplish a task. 

They sought a robust solution to overhaul their application landscape and enhance operations due to the traditional contact center model's inability to meet increasing demands, causing key challenges including, but not limited to:

  • Fragmented infrastructure, consisting of over 30 siloed applications, leads to inefficient and disconnected integration.
  • Legacy systems posed maintenance and upgrade challenges which resulted in accumulated technical debt.
  • Ineffective and impersonal customer service caused extended wait times due to manual intake processes.
  • Lack of UX design standards resulted in applications having varied experiences for similar functionalities, increasing the adoption time and reducing the reusability of the feature. 
  • Inconsistent user experience leading to increased training overheads.

Journey from evaluation to recommendation

  • Virtusa evaluated the client's contact center applications, creating a roadmap centered on upgrading and re-engineering the legacy system. We employed our unique Triple R methodology: Recon, Refactor, and Re-platform. 
  • Our consulting approach enabled the client to harness the latest advancements in the Pega Platform and Voice AI technology, leading to the first Pega Voice AI in the healthcare payer industry.


Arriving at the smart solution

Virtusa leveraged its unique Recon, Refactor, and Re-platform (Triple R) methodology to upgrade the client's existing system to Pega 7.3.1 before upgrading to the latest versions of Pega 8.x using a co-existence approach for a seamless rollout. Our approach has helped us identify the opportunity to upgrade the existing environments to the latest Pega version, Pega Infinity. 

  • Utilized Pega Upgrade Factory Model to constantly upgrade their platforms to the latest versions of Pega ensuring the latest and greatest features are available.
  • Set up Robotics COE and identified 100+ automation use cases across key service applications.
  • Implemented Next Best Actions, Predictive Claims, and Predictive Analytics by leveraging Pega CDH to optimize efficiency. 
  • Established the UX governance model to align with the design thinking methodology for iterative improvements to provide a unified digital experience to the end users.
  • Developed a set of reusable components and frameworks to boost ROI and expedite future application enhancements.
  • Introduced the Pega Cosmos Design system for consistent visual appeal and improved user experience.
Virtusa empowers major payer's contact center transformation with cutting-edge tech

Additionally, Virtusa also collaborated with the client to pioneer the first Pega Voice AI Implementation in the Healthcare Payer Industry, delivering an intuitive and personalized customer service solution for both customers and agents.

  • Introduced a co-pilot feature for contact center agents to enhance their efficiency and improve constituent experience.
  • Executed high-value, high-impact use cases such as HIPAA Compliance, Automated form filling, script adherence, and intent task suggestion by leveraging the next best action during the pilot rollout.
Benefits reaped by the client

Virtusa helped the client drive substantial improvements and savings in its contact center experience including:

  • 30% overall improvement in CSAT.
  • 20% reduced average handling time.
  • Improved FCR by 98% using digital messaging and conversational AI.
  • 25% higher operational efficiency.
  • 40% reduction in technical debt.
  • Achieved $1.7 million in cost savings.
  • The global design system ensured that UX followed brand standards and guidelines, ensuring a consistent interaction experience.
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