Modernizing Member and Provider Engagement with AI

Modernizing member and provider engagement with an AI-powered contact center

Transforming IVR experiences with Microsoft Dynamics 365 and conversational AI

6 min 所要時間

Overview

A leading US dental benefits organization partnered with us to modernize its high-volume member and provider engagement platform. This initiative replaced a legacy Nuance Interactive Voice Response (IVR) system with a modern, intelligent contact center solution built on Microsoft Dynamics 365 Contact Center.

The transformation extends beyond technology migration. It reimagined how members, providers and dentists interact with the organization, replacing rigid menu-driven journeys with conversational self-service experiences. The new platform supports millions of annual member and provider interactions and approximately 850 contact center agents while establishing a scalable foundation for omnichannel engagement, AI-driven automation and future innovation.

The Challenge

The client needed to replace its aging IVR platform without disrupting high-volume service operations. The transformation also created an opportunity to move beyond menu-heavy interactions toward a more natural, intent-driven self-service experience.

Key challenges included:

Large-scale member and provider call volumes requiring stable, always-on IVR performance.
Risk of business disruption from legacy platform retirement.
Need to maintain containment, routing accuracy, abandonment and service-level performance during migration.
Opportunity to introduce natural language understanding (NLU) to reduce menu dependency and improve caller experience.

The program was therefore positioned not as a like-for-like migration, but as a controlled modernization of the contact center foundation.

The Objective

Deliver a seamless migration to Microsoft Dynamics 365 Contact Center that achieves three core outcomes:

Significantly improve the customer experience through natural, intent-driven interactions.
Increase operational efficiency and self-service containment.
Build a future-ready foundation for omnichannel, analytics and generative AI initiatives.

The Solution

HCLTech is developing the NextGen IVR, with a minimum viable product (MVP) planned as the platform's first production release.

The solution combines cloud contact center modernization, NLU-enabled conversational IVR, intent-based routing and analytics-ready reporting on a single scalable platform, improving self-service while protecting operational stability.

NLU-enabled IVR

Callers can express their needs in natural language, with intent models and call flows designed around common journeys for members, providers, dentists, eligibility, claims and benefits.

Intent models and utterance libraries tailored to dental benefits and servicing needs.
Conversational dialog flows spanning eligibility, benefits, claims, pre-treatment and materials requests.
Intent-based routing that passes richer context to advocates for faster, better-informed resolution.
Speech tuning and call flow optimization to improve recognition quality over time.

Cloud contact center foundation

Microsoft Dynamics 365 Contact Center provides a scalable platform for IVR modernization, omnichannel readiness, analytics and innovation in future service experience.

Configurable call flows, routing logic and self-service journeys.
Integrated speech engineering, NLU model tuning, testing and release readiness.
Architecture designed for analytics, digital deflection and future GenAI evaluation.

Phased, business-aligned delivery

The program is delivered through a blended onshore-offshore agile model with phased releases.

30+ full-time equivalents across platform configuration, speech engineering, NLU design, QA, integration and healthcare operations.
Phased rollout across member and provider IVR, aligned to volume peaks and operational readiness.
More than 3,200 test cases executed across functional, business, NLU and end-to-end streams, with zero critical defects at go-live.

Go-live and hypercare support

A structured post-go-live model is established to safeguard service performance and enable rapid issue resolution during stabilization.

Enterprise support model covering on-call, ticket management and major incident triage.
Daily structured status calls for metrics review, issue surfacing and clear ownership.
Dedicated communication channels for real-time collaboration and issue tracking across teams.
Real-time monitoring for proactive visibility into system health and performance.

As part of this engagement, HCLTech will continue to enhance the platform by delivering MVP2 and MVP3, introducing additional member capabilities such as Dentist Search, Provider Assignment and Payment Experiences, while expanding the rollout to additional member groups.

The Impact

The transformation is expected to deliver a safer migration, a more intuitive caller experience and a stronger foundation for future contact center modernization.

Expected outcomes

100% migration from the legacy Nuance platform to Microsoft Dynamics 365 Contact Center.
Zero degradation in key performance measurement (containment, routing accuracy, abandonment rate, service levels).
Continuity of operations across approximately 850 contact center agents.
Platform resilience and scalability.

Anticipated experience and efficiency uplift

Progressive improvements as NLU models mature and self-service journeys are optimized.

KPI	Baseline	6 months target	North star
Call containment	23%	>30%	>60%
Transfer rate	77%	<70%	<40%
Average time in IVR	2.5 min	2 min	1.5 min
Customer effort score	2.7	3.5 (70%)	>4.3 (83%)

Alongside these metrics, the program is expected to improve first-contact resolution by directing callers to the right self-service path or agent queue faster and enhance caller satisfaction through more natural, lower-effort interactions.

Projected business value realization

Stage	Annual Value	Driver
Current	~$15M	Baseline savings from existing IVR automation
6 months	~$19.6M	Improved containment and efficiency post-modernization
North star	Up to $39M	Optimal IVR performance and self-service maturity

Conclusion

By partnering with HCLTech, this leading dental benefits organization has transformed its contact center into an intelligent, AI-powered engagement platform. The new solution delivers personalized experiences while creating a scalable foundation for ongoing innovation in analytics and generative AI. This modernization strengthens service excellence today and positions the organization for continued leadership in the future.