Where to Apply Humans vs. AI in the Health Insurance Contact Center

The contact center plays a critical role within health plans—it’s often the primary channel for building meaningful relationships with members. Every interaction is a chance to deliver clarity, empathy, and support in moments that matter. Whether it’s a question about coverage or a complex process like a prior authorization or appeal, how that conversation is handled shapes trust and perception.

Technology is only part of the solution. Real service still hinges on human connection. Even the most advanced tools can fall short without a focus on empathy and personalization. Members may not recall every benefit detail—but they remember how they were treated. When payers combine smart technology with a human-centered approach, they turn their contact centers into powerful drivers of loyalty, resolution, and trust.

The Human Touch: Strategies for Meaningful Interactions

Creating more meaningful member experiences doesn’t happen by chance—it takes deliberate, strategic shifts. As expectations rise, payers need to evolve their contact centers from transactional support hubs into relationship-building engines.

That means using technology to empower—not replace—human connection. Here’s where to start:

• Empower agents to lead with warmth and empathy
  Use AI-powered tools to lift the administrative burden. Let automation handle tasks like notetaking and data analysis so agents can focus on what matters most: connecting with members. This shift frees up time for more personalized, empathetic conversations. Cigna is blending automation with human support by using AI to streamline routine tasks, expand virtual care options, and introduce concierge teams—enhancing both efficiency and the member experience. Tools such as NICE CXone, Genesys, and CallMiner make this possible.
  


• Use data to fuel real-time coaching and development
  Move beyond manual call audits. With the ability to review 100% of call transcripts seamlessly with AI, you can deliver personalized feedback at scale. This enables every interaction to become a coaching moment—strengthening soft skills, improving outcomes, and building a culture of continuous improvement.
  


• Balance automation with human touchpoints
  Automate simple transactions—but save human interaction for the moments that require nuance and care. Make sure contact center channels are connected so context carries over. For example, if a member explores their benefits online and then calls in, the agent should pick up the conversation without missing a beat. Likewise, insights from human conversations should inform automated follow-ups. This kind of seamless, cross-channel experience shows members they’re heard—and builds trust. And when a situation calls for empathy? Make it easy for members to reach a real person.

Fueling Loyalty by Making Every Interaction Count

Your contact center isn’t just a function—it’s your loyalty engine. When you reduce friction for agents, use data to drive smarter coaching, and design interactions that blend empathy with efficiency, you build more than operational success. You build trust.

In healthcare, opportunities to connect with members are limited. That’s why every conversation, whether human or automated, needs to be seamless, personal, and rooted in understanding. By getting this right, payers can turn everyday interactions into lasting relationships—and elevate the member experience at every turn.

Authors: Kate Kiyosaki, Benjamin Baenen, Tory Sharp