Company: Optum, Eden Prairie, MN
Company Description: Optum is a health services and innovation company whose mission is to help people live healthier lives and to help make the health system better for everyone. At Optum, we design every experience by leveraging the voice of our customers and implement channel solutions which enhance and streamline the customer experience.
Nomination Category: Customer Service & Call Center Awards Achievement Categories
Nomination Sub Category: Best Use of Customer Insight
 Nomination Title: AARP Benefit Coverage Virtual Agent and Gym Membership Expansion: Leveraging Customer Insight
- Which will you submit for your nomination in this category, a video of up to five (5) minutes, explaining the nominated achievement since July 1, 2021, OR written answers to the questions? (Choose one):
Written answers to the questions
- If you are submitting a video of up to five (5) minutes in length, provide the URL of the video here, OR attach it to your entry via the "Add Attachments, Videos, or Links to This Entry" link above, through which you may also upload a copy of your video. If you are submitting written answers to the questions for this category, provide them in the spaces below.
Written responses included below. Supporting documents also attached for reference.
- Briefly describe the nominated organization: its history and past performance (up to 200 words):
Optum is a health services and innovation company whose mission is to help people live healthier lives and to help make the health system better for everyone. At Optum, we design every experience by leveraging the voice of our customers and implement channel solutions which enhance and streamline the customer experience. This model drives our one-to-one interactions through a consumer centric lens to deliver simple, smart, and seamless experiences for the customers we serve.
- Outline the nominated achievement since July 1 2021 that you wish to bring to the judges' attention (up to 250 words):
Within the Optum Enterprise Shared Services team, we deliver actionable strategies based on data-driven insights to deploy optimized member and provider experiences.
In 2021, we identified a unique top call driver (25% of contact center volume) with a dropping net promoter score (NPS) score within one of Optum’s largest business segments supporting AARP United Health Care (UHC) Medicare Supplement plans. These members wanted assistance in understanding what benefits were covered under their plan. This presented an opportunity to deliver more robust and delightful customer experiences by providing a dynamic and conversational dialogue leveraging AI (artificial intelligence) generated virtual agent aka bot.
We constructed analysis listening to ~400 call samples in which we categorized by top benefit type. We then engaged in agent focus groups ranking categories based on complexity of standard operating procedures. Our analysis provided a foundation to select top questions and construct conversational designs answering in a way the customer could easily understand as opposed to lengthy replies with unnecessary health care jargon.
On September 13th, 2022, we used voice bot technology (Microsoft Azure) and successfully deployed a Benefit Coverage Virtual Agent with top 15 procedure and vaccine questions. Initial results indicated members easily engaged with the bot with a higher than anticipated 60% in-scope containment rate! Post deployment, we reviewed call transcriptions and found customers asking questions about benefits not in our scope. This enabled us to identify opportunities using real experience. Supplementary discovery highlighted ~1,000 members a month specifically asking about gym membership benefit questions.
- Reference any attachments of supporting materials throughout this nomination and how they provide evidence of the claims you have made in this nomination (up to 250 words):
Our supporting document includes a PDF highlighting the Benefit Coverage journey, high level experience flow and target goals, results and recordings and actual transcripts leveraged for insight. Also included for reference, real customer call recording audio examples showcasing the end result and outcome of leveraging customer insights.
- Explain why the achievement you have highlighted is unique or significant. If possible compare the achievement to the performance of other players in your industry and/or to the organization's past performance (up to 250 words):
This fascinating discovery and customer insight on gym memberships created a new opportunity to expand but also made this effort even more noteworthy and significant. After collaborating with business stakeholders across AARP and UHC, came meaningful details about the Renew Active advantage where members needed a simple confirmation code to access free gym memberships.
We took this data and designed a new interactive bot experience which could provide members with a gym code along with instructions on what to do next to take advantage of their gym membership benefits. Our customers benefited by being able to quickly get what they need without having to talk to anyone. This was a win for both our members and our business partners.
We targeted goals of ~12,000 increased in-scope volume with 50% containment, resulting in ~6,000 more calls contained annually. The Gym Membership bot (within original Benefit Coverage Virtual Agent) deployed on June 28th, 2023. Preliminary results measurement has exceeded estimates: August results show in-scope volume increasing by 122% and in-scope containment rate increasing by 4%.
Listening and leveraging customer insight created our initial bot pilot focused on improving and simplifying member experiences when calling in about benefit questions. Data and direct voice of the customer feedback led us to enhance and expand the bot to allow more members to simply self-serve.
Our intentional focus to leverage customer insight drove a significantly better caller experience and reduced costs allowing contact center agents to handle more complex calls.
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