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CASE STUDY — AGENTIC AI / HEALTHCARE

A virtual concierge that answers members in seconds.

We built a regional health plan an agentic AI assistant — grounded in their own benefits, claims, and pharmacy data — that deflects a third of call volume across every channel.
3M+ members
Agentic RAG
Azure AI Foundry
Omnichannel

35–40%

Call deflection

$950K

Annual savings

Seconds

Avg. resolution

24/7

Security, monitoring, auditability, adoption
35-40%
Call deflection
$950K
Annual savings
Seconds
Avg. resolution
24/7
Every channel

The challenge

Open enrollment broke the call center.

Thousands of calls a day, most of them routine — and agents stuck searching siloed systems instead of helping.
  • Volume spikes
Hold times and abandonment climbed past every target during peak weeks.
  • Siloed data
Reps lost 30–40% of each call hunting across disconnected systems.
  • Agent burnout
Simple questions crowded out complex cases, driving turnover.
  • Inconsistent answers
Phone, email, and chat gave different responses to the same question.
  • Inconsistent answers
Phone, email, and chat gave different responses to the same question.
  • Slow resolution
First-call resolution lagged; average handle time kept climbing.
  • No visibility
Staffing gaps went unnoticed until service levels had already dipped.

The approach

One assistant, wired into enterprise data.

The concierge connects every member channel to the systems that hold the real answers — and reasons over them live.

Meets members on phone, email, SMS, web & mobile

Pulls from CRM, billing, scheduling & claims

Nothing stored assistant-side — every answer is live

Personalized, member-specific responses

How it works

Ask anywhere. Grounded every time.

Built on Azure AI Foundry with the latest OpenAI GPT models as the reasoning engine.

01

Any channel

Voice, web, mobile, email & SMS route through one orchestration layer.

02

Understand

The GPT model interprets intent — even nuanced coverage questions.

03

Ground

AI Search retrieves live plan, claims & member data in real time.

04

Respond

Answers stay scoped to that data, cutting fabricated responses.

Built on

The stack

Azure AI Foundry · GPT reasoning

Azure Bot Service · orchestration

Azure AI Search · retrieval

Speech Services · voice

Communication Services · channels

Azure AD B2C · auth & MFA

Deflect a third of your calls in 90 days.

Let’s scope what an agentic concierge looks like for your members.
info@cibersql.com
1 (800) 397-4507
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