Transforming Large-Scale Healthcare with Omnichannel AI

Overview

A large U.S.-based healthcare and insurance organization serving more than 12 million members set out to modernize how it engages members across digital and assisted service channels. As member expectations increased and healthcare journeys became more complex, the organization recognized the need to strengthen automated digital self-service while also improving assisted experiences where members interact with human agents.

The organization partnered with Kore.ai to support this transformation using AI for Service, an agentic customer service platform designed to unify automated self-service and human-assisted engagement within a single, intelligent service model. This approach enabled the organization to streamline operations, improve consistency across channels, and establish a scalable foundation for adaptive, AI-led member experiences.

The Challenge

As digital engagement expanded, the organization faced growing pressure to deliver consistent, high-quality service across web, mobile, and contact center interactions—while managing cost, complexity, and compliance at scale. Fragmented service experiences and heavy reliance on assisted support made it difficult to meet rising member expectations efficiently.

Key pain points included:

• Disconnected digital and assisted service channels, leading to inconsistent member experiences
• Low self-service containment, increasing dependency on live agents for routine requests
• Limited personalization across member journeys, reducing engagement and satisfaction
• Inefficient contact center operations driven by manual workflows and channel silos
• Lack of a unified, future-ready platform to support evolving service models

With millions of members and a broad range of healthcare interactions, the organization needed a scalable way to unify engagement and improve service delivery without adding operational burden.

The Solution

The organization partnered with Kore.ai to modernize member engagement using AI for Service, unifying automated self-service and assisted support within a single, orchestrated environment. The platform enabled AI-led automation and intelligent agent assistance while maintaining flexibility, governance, and control across channels.

Through this implementation, the organization established:

• An AI-driven omnichannel service platform spanning web, mobile, voice, and assisted interactions
• AI Agents for automated self-service, handling high-volume, repeatable member inquiries
• Agent AI–powered assistance supporting human agents during complex or sensitive interactions
• Centralized orchestration and routing, dynamically directing interactions to the most appropriate channel
• Context-aware personalization, enabling intent-based experiences and next-best actions
• A composable, future-ready architecture allowing teams to iterate, expand, and optimize over time

This foundation gave the organization the flexibility to evolve service delivery while maintaining consistency across member journeys.

Business Impact

With its agentic service foundation in place, the organization achieved meaningful improvements across efficiency, experience, and scalability for both members and service teams.

Key outcomes included:

• Reduced dependency on the contact center as routine interactions shifted to automated self-service
• Improved digital containment, lowering overall assisted-service demand
• More consistent member experiences across web, mobile, voice, and live agent interactions
• Stronger support for human agents through real-time intelligence and guidance
• Faster response times for common member requests
• A scalable operating model enabling growth without proportional increases in cost or staffing

Together, these outcomes helped streamline operations, improve service quality, and empower teams to focus on higher-value member needs.

Client Testimonial

“This transformation is about raising the bar—not just implementing technology, but evolving how healthcare support is delivered. With Kore.ai, we moved from siloed experiences to a modern, scalable, member-centric service ecosystem.”
— Senior Digital Transformation Leader, U.S. Healthcare Organization

The Kore.ai Advantage

Kore.ai provided an enterprise-grade foundation designed to support the scale, complexity, and regulatory requirements of healthcare and insurance organizations. Built on the AI for Service platform, Kore.ai unified automated self-service and assisted support across digital, voice, and live agent interactions within a single orchestrated environment.

A composable architecture enabled the organization to expand automation over time and adapt engagement models as member needs evolved. Enterprise-grade security and governance supported regulated healthcare environments, while analytics-driven optimization gave teams visibility into performance and intent coverage—helping refine journeys, improve containment, and deliver consistent, high-quality engagement at scale.