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decrease in average talk time


annual program savings


predicting member satisfaction on 100 percent of phone conversations


fortune 100 healthcare company






The Challenge

Choosing the right plan or simply getting answers to healthcare questions can be daunting for anyone, let alone one of the 44 million people enrolled in Medicare programs today. Providers are painfully aware of the connection between the member experience and the Medicare Star Ratings—a key driver of plan enrollment and the bottom line.

As one of the leading national providers of Medicare Advantage, this healthcare company had a vested interest in helping members understand and access Medicare benefits and efficiently resolve issues with healthcare services. The company was also interested in measuring member satisfaction, but lacked the insights and tools necessary to drive measureable improvements.

The Solution

First, with Mattersight’s Predictive Behavioral Routing (PBR), this company improved the member experience through shorter, more efficient calls. PBR uses artificial intelligence and a proprietary database with more than 120 million behavioral profiles to pair members with the agent best equipped to handle their request and accommodate their unique personality style.

Next, by adding Mattersight Predictive Metrics, a member satisfaction score is predicted on 100 percent of member phone conversations. Mattersight combines powerful algorithms and actual member surveys to develop a model that predicts the satisfaction score a member would give after a phone call. The resulting satisfaction scores and insights are used to improve routing and provide personalized coaching to drive service improvement.

“Mattersight is comprised of innovative people and technology that are helping us transform how we interact with our members, led by passionate people who care about their customers and their needs.”

-Program Leader

The Results

Mattersight’s solution was deployed and running smoothly ahead of the annual member open enrollment period. PBR quickly increased efficiency and drove down costs.

The Predictive Metric analysis identified individual agents most impacting member satisfaction scores both positively and negatively. Armed with these valuable insights, the company now has the visibility needed to implement focused improvements. Since multiple business process outsourcers were used to handle calls, an added bonus was improved vendor management.

See how Predictive Behavioral Routing can benefit your contact center.

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