The Contact Center Crossroads
For decades, healthcare and insurance contact centers have walked a fine line between efficiency and empathy. Customers need real-time answers to deeply personal questions about care, coverage, or claims—yet these inquiries often funnel into manual, high-volume workflows built for another era.
Inbound volume has climbed as much as 35% year over year (Gartner), while 72% of contact center leaders cite difficulty hiring and retaining agents (Deloitte). Meanwhile, 88% of customers say the experience a company provides matters as much as its products or services (Salesforce).
Together, these pressures are forcing a fundamental rethink of how service gets delivered — not just faster, but smarter, safer, and more human.
The traditional fixes — more headcount, more outsourcing, more scripts — no longer scale. What does scale is AI-powered self-service, purpose-built for regulated industries. It’s not about replacing people; it’s about removing the friction that keeps them from delivering high-value care and connection.
In this environment, the question is no longer if AI can help, but how it should.
Beyond the Chatbot: From Reactive Automation to Outcome-Oriented AI
Most automation in service still lives in the past — simple bots that route tickets or handle FAQs. They don’t understand intent, process complexity, or regulatory context. They respond, but they don’t resolve.
Agentic AI changes that. It’s built for proactive, goal-oriented engagement that turns conversations into outcomes. These systems interpret what a customer needs, retrieve context from enterprise data, and take compliant action to move the interaction forward.
When a policyholder checks a claim status, Agentic AI doesn’t just provide an answer — it verifies identity, updates the record, triggers the next workflow, and closes the loop securely and automatically.
This isn’t automation for efficiency’s sake. It’s automation with intent — AI designed to deliver measurable results, reduce friction, and scale the kind of dependable service that builds trust.
AI-Powered Self-Service in Action
What does effective AI-powered self-service look like in healthcare and insurance?
- Call deflection to digital: When a member calls into the IVR, an AI Agent can offer to complete their task via a secure digital channel like Ushur’s Invisible App™—no wait time, no login, fully compliant.
- Proactive communication: Instead of waiting for calls, AI Agents can automatically remind patients about appointments, policy renewals, or documentation needs—helping prevent the very inbound volume that overwhelms contact centers.
- Document and data automation: AI extracts and validates information from emails and forms, updating backend systems automatically and cutting cycle times from days to hours.
- Human collaboration: When empathy is essential, AI transfers full context to a live agent, creating continuity instead of chaos.
According to McKinsey, AI can automate 30–50% of inbound contact center tasks while maintaining or improving quality. Enterprises using compliant, domain-trained AI are already outperforming those benchmarks — reducing cost-to-serve, accelerating resolution, and improving satisfaction at scale.
AI for Regulated Industries: Compliance Built In, Not Bolted On
Automation in healthcare and insurance must meet a higher bar. Each interaction can touch protected health or personal data, and every step must withstand audit scrutiny.
Modern platforms built for regulated industries integrate security, compliance, and governance into the core of their architecture — not as afterthoughts.
That includes:
- End-to-end AES-256 encryption for data in transit and at rest
- Zero data retention unless explicitly required
- Role-based access controls for authorized users
- Continuous human oversight, monitoring, and audit logging
This compliance-first design enables enterprises to digitize complex journeys — from claims and onboarding to billing and benefits — while maintaining the trust that regulation demands.
Curious what this looks like in action? Take a look at what security and compliance look like for Ushur’s agentic AI.
What Transformation Looks Like
- Group Benefits Carrier: For leave-of-absence management, one Fortune 250 group benefits carrier replaced paper forms and outbound calls with secure digital workflows, achieving an 85% engagement rate, a 42% reduction in outbound calls, and 90% campaign completion within one hour.
- Cigna: By automating claim status updates and leveraging AI to classify and route incoming emails, Cigna reduced claim-related call volume by 40–50%. That freed agents to focus on complex cases and improved both efficiency and customer satisfaction.
- Healthcare Payer: A large Medicaid and Medicare health plan serving nearly two million members deployed Ushur’s AI Agent for member service to deliver 24×7 digital self-service support. Within two months, 21% of inbound inquiries were deflected to digital channels, and 20% were handled after hours, reducing agent load and improving member satisfaction.
Each example illustrates a consistent shift: AI delivering efficiency and empathy — faster, compliant service without losing the human touch.
From Contact Center Modernization to AI Readiness
AI isn’t replacing the contact center — it’s reshaping it around outcomes.
The next evolution for healthcare and insurance service teams isn’t about more bots or new channels. It’s about governed, goal-driven automation that can safely operate in regulated environments while delivering measurable business results.
The transformation typically follows three stages:
- Start with high-frequency inquiries — Identify high-friction journeys that AI can securely automate, such as claims, eligibility, and onboarding.
- Establish governance — Define guardrails for compliance, transparency, and auditability from day one.
- Evolve toward a “Command Center” model — Where AI continuously learns from interactions and improves future performance.
That foundation separates those experimenting with AI from those operationalizing it. The goal isn’t just to deploy automation — it’s to build a sustainable, compliant framework for customer experience at scale.
A Better Model for Service and Care
The question for healthcare and insurance leaders isn’t whether to adopt AI, but how to do it responsibly — in a way that protects compliance, customer trust, and operational integrity.
That starts with two fundamentals:
- Governance: Establishing the policies, safeguards, and oversight that make AI compliant, explainable, and auditable. Ushur’s AI Agent Governance & Safety framework outlines what those guardrails look like in practice.
- Readiness: Building the processes and teams that can put those guardrails to work. Getting Ready for Your AI Agent details how to operationalize responsible AI and move from experimentation to measurable results.
The future of service will belong to organizations that deliver both intelligence and integrity at scale — systems that move fast and do the right thing. That’s not just a technology challenge.
It’s a leadership one.