Health plan modernizes member and provider experiences with data, automation and AI 

The challenge 

A leading health plan struggled to give employees a unified view of member details — leaving critical data scattered across multiple systems. At the same time, support teams were spending extra hours manually processing routine provider requests for prior care authorizations. Without enough internal capacity to manage ongoing updates to their Microsoft Dynamics 365 and Genesys Cloud CX platforms, both call backlogs and provider frustration grew.

The solution

TTEC Digital overhauled the health plan’s core digital workflows to streamline care delivery:

• Unified member data: Integrated scattered medical and claims data into a real-time dashboard using Microsoft Dynamics 365.
• Automated provider requests: Deployed conversational AI and automated workflows on Genesys Cloud CX to process, verify, and approve routine authorization inquiries instantly.
• Platform support & testing: Provided dedicated engineers for continuous system updates, bug fixes, and quality testing across both environments.

The results

Automated self-service tools now handle routine authorizations immediately, reducing provider wait times and freeing call center staff to focus on complex cases. Support agents view complete member histories on a single screen, resolving inquiries faster without repeating questions. By maintaining continuous platform testing and support across Microsoft and Genesys, the health plan eliminated system downtime and established a secure foundation for future AI expansion.
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“This transformation shows what’s possible when unified data, intelligent automation, and thoughtful service design come together. This is one example of how TTEC Digital is helping health plans turn member insight into action, simplify high-friction provider interactions, and build a scalable foundation for more connected, personalized service.”

Ross Lotharius, Global Microsoft Practice Lead, TTEC Digital