Provider search and directory confusion
What shows up
Members repeatedly contact the plan to confirm whether a physician is in network, even when a digital provider search exists.
- What it may reveal upstream
- Provider directory quality, confusing network language, a search experience members do not trust, or gaps in onboarding communication.
- What TrueAssist helps change
- The source of the confusion: directory processes, network education, search experience, or member communications. Not only how fast the call gets answered.
- What to measure
- Network-status contact volume
- Digital search completion
- Repeat contacts on the same provider
First-30-day member friction
What shows up
New members contact the plan repeatedly shortly after enrollment, often about the same handful of things.
- What it may reveal upstream
- Predictable gaps in ID card delivery, PCP selection, pharmacy setup, activation, benefits understanding, or the handoff between enrollment and service.
- What TrueAssist helps change
- The new-member journey itself, so predictable contacts are prevented rather than staffed for.
- What to measure
- Contacts per new member in the first 30 days
- Contact reasons that repeat across new members
- Early disenrollment and cancellation
Claims and EOB confusion
What shows up
Members call after claims are processed because they do not understand what happened or what they owe.
- What it may reveal upstream
- EOB language, claims-status communication, self-service design, or how benefits are explained at the point of service.
- What TrueAssist helps change
- Communication and workflow upstream of the contact center, plus the agent workflow and knowledge for the calls that remain.
- What to measure
- Claims and EOB inquiry volume
- Repeat contacts on the same claim
- Complaints and grievances tied to claims
Enrollment conversation friction
What shows up
Prospective members hesitate, abandon, or fail to complete enrollment at similar points in the conversation.
- What it may reveal upstream
- Script friction, confusing plan explanations, eligibility uncertainty, process complexity, agent workflow, or routing. Rarely an agent who needs to sell harder.
- What TrueAssist helps change
- The enrollment conversation and the process behind it: where it breaks, and what it asks of the consumer at that moment.
- What to measure
- Conversion at each stage of the conversation
- Effectuation
- Enrollment handle time and callbacks
Agent and caller match
What shows up
Some agents consistently perform better with certain caller needs, communication styles, or levels of complexity, even when the obvious variables look similar.
- What it may reveal upstream
- Routing that treats qualified agents as interchangeable when interaction and performance data suggest more useful pairing logic.
- What TrueAssist helps change
- Routing strategy, built on the routing and analytics technology already in place.
- What to measure
- Resolution and conversion by pairing
- Transfers
- Customer experience measures by caller type
IVR menu friction and intent routing
What shows up
A caller navigates multiple menu layers, but the selected path does not meaningfully change the destination or the context the agent receives.
- What it may reveal upstream
- Intent capture, menu language, routing rules, skills, or agent context that is not doing the work it was designed for.
- What TrueAssist helps change
- IVR and conversational AI design, intent routing, and what the agent sees when the call arrives.
- What to measure
- Containment where it is appropriate
- Transfers and misroutes
- Callers re-explaining their need to the agent
What shows up
The same member contacts the plan again within days of a transfer, an escalation, or a promised follow-up.
- What it may reveal upstream
- Handoffs between teams or systems that lose context, follow-up workflows nobody owns, or resolution being recorded before it actually happens.
- What TrueAssist helps change
- Handoff design, case ownership, and follow-up workflow across teams and systems.
- What to measure
- Repeat contact rate after a handoff
- First-contact resolution
- Escalations and complaints
BPO and vendor handoff visibility
What shows up
Interactions cross between internal teams and one or more outsourced partners, and each side reports on its own slice.
- What it may reveal upstream
- Inconsistent workflows, knowledge, and quality standards across partners, and incentives that reward volume handled rather than volume prevented.
- What TrueAssist helps change
- The vendor operating model, shared quality and reporting across partners, and how work is handed between them.
- What to measure
- Outcomes compared across internal and partner teams
- Transfers between partners
- Repeat contacts that cross a handoff
