Call center transformation future-proofs PBM for lower cost, unified member experience

Challenge

An established, mid-market pharmacy benefit manager required a member journey transformation in late 2022. Existing call center operations were disjointed and highly manual, resulting in extended hold times, lost transfers, and unacceptable levels of abandoned calls. Member abrasion and agent frustration characterized the experience. The PBM’s technology stack was lagging and needed an upgrade to provide the necessary integrations and member self-service functions needed to deliver results. The company awarded the project to EXL.

EXL met with the client to discuss the scope of work in September, completing the initial scope and project roadmap in late October. Success indicators identified were reducing member communication times and call volumes handled by live service agents, along with a marked improvement in member satisfaction.

Solution

EXL’s rapid assessment included a full review of documentation, process flows, policies and procedures, job descriptions, client surveys, business metrics, and in-depth interviews with critical stakeholders and subject matter experts. On approval of the scope, work commenced, prioritizing efforts in two areas: the member contact center and overall technology stack.

To start, EXL focused on creating a single data source to support a unified face of the company in member engagements. This required system integrations across the tech stack so that departments could communicate in near real-time.

An omni-channel contact center platform, hosted on AWS Connect, accommodated a future-state ecosystem. Capabilities included EXL EXELIA.AI™ conversational AI solution, featuring natural language processing (NLP), as well as a smart agent desktop, work-from-home support, and integrations with key operating systems. The resulting unified desktop improved agent experience and productivity, providing a 360° member view, structured call summarizations, sentiment analysis, and automated customer satisfaction scoring (CSAT).

Following the implementation, EXL transitioned the client to extended support, continuously monitoring the environment, analyzing interactions, and improving virtual agent performance.

“EXL has gone above and beyond to make things work for us. We are pleased to report marked improvements in all key performance areas.”

– Lead product coordinator, mid-market PBM

Outcomes

The solution went live in the fall of 2022, in time for the client’s peak enrollment season in January. In the initial weeks, the client has reported the following results:

“We were able to accomplish great things together and your team’s performance was and continues to be outstanding. I’ve worked with so many vendors in my career and I can honestly say your team was my absolute favorite. Their expertise and spirit of partnership was unparalleled as well as their flexibility and professionalism.”

– VP, Member Services, mid-market PBM

The client and EXL hasn’t stopped yet, as additional innovations are being implemented in 2024 to continue to improve the member journey.

To learn more about EXL’s PBM solutions, please visit EXLservice.com.