Enhancing Member Experience and Service Quality with Generative AI
Enhancing Member Experience and Service Quality with Generative AI
4 PagesC3.ai's case study details how their C3 Generative AI for Customer Service transformed operations for Pharmacy Benefit Managers (PBMs). The document outlines challenges faced by PBMs, including navigating complex healthcare systems, managing urgent medication inquiries, ensuring HIPAA compliance with sensitive PHI, and dealing with disparate applications and steep training. The C3 Generative AI solution enabled a significant reduction in total call duration by 15.6% and improved first-call resolution rates. It unified data access, provided deterministic responses, and integrated deeply with healthcare systems, allowing representatives to proactively guide members to full resolution. This enterprise-grade AI enhanced customer service quality, maintained compliance, and optimized operational
