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Case Study

Elevance Health delivers personalized customer experiences with Pega

  • 3-minute drop in AHT
  • 11-point increase in NPS
  • 50% decrease in training time

"What you’re looking for [as a member] is somebody to be there in that journey when you need them most. And that’s what Pega is doing with us."

The business issue

One of the U.S.’s leading health benefit companies, Elevance Health has been evolving from a traditional health insurance payer to one that is primarily focused on advancing health, improving lives, and simplifying care. To help accomplish this, Elevance focuses on improving operational efficiencies while enhancing both member and associate (agent) experiences.

Like many employers, Elevance faced workforce challenges that included high turnover rates as well as the costs of recruitment and training. The company found that one of the main reasons why its agents were leaving was because their jobs were riddled with complexity. Elevance recognized that it needed to transform member and associate experiences.

The solution

Elevance partnered with Pega to reimagine its member and associate experiences. The company has been working with Pega for more than a decade, expanding originally from back-office claims management to front-office customer service and, most recently, to Pega Voice AI™.

Using Pega Customer Service™, Elevance Health created Solution Central, a next-generation associate desktop that breaks down silos and enables real-time access to information across the enterprise. This contextual desktop guides associates through workflows, making their jobs easier so they can focus on the member experience. Associates receive prompts with knowledge content and suggested actions at the right time, reducing context switching and accelerating resolutions for members. This has resulted in a 50% decrease in associate training time and an 11-point increase in NPS.

Elevance is now expanding Solution Central by rolling out Pega’s real-time Voice AI to its associates. Acting as an autonomous co-pilot, Voice AI guides associates by recommending specific case workflows, suggesting relevant knowledge articles, providing dynamic scripts for associates, and confirming script adherence. Voice AI also automates manual work by automatically completing forms and reducing wrap-up time. This industry-leading technology has significantly lightened the burden on associates’ shoulders, enabling them to focus on delivering more empathetic, value-driven service. Elevance’s continuous path of transformation is paving the way for the future of health for its members and beyond.

The results

  • 3-minute drop in AHT
  • 11-point increase in NPS
  • 50% decrease in training time
  • Hundreds of automated processes
  • More than 10,000 Pega Customer Service users
  • Less than 90 days to initial delivery for Solution Central

Find out how Elevance uses Pega’s Voice AI to transform agent and customer experiences

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Industry: Healthcare Product Area: Customer Service Solution Area: Customer Service
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