Health Exchange Solves Errors and Authentication Issues with Vistio


A state health exchange client operates an online marketplace where residents of their state can sign up for health insurance. As the open enrollment period neared, the organization’s contact center sought to improve their customer service process and reduce issues that were leading to poor customer experience such as long hold times and agents providing incorrect responses. One of their internal processes, for example, required the agent to call an internal helpline to ask for approval for certain cases, a process that ballooned both handle times and hold times.

The client also wanted to decrease the frequency with which agents mistakenly open up new policies. Finding policy information in their CRM proved to be difficult for agents, so when customers called in to ask for a new policy, agents would often have difficulty determining if that individual already had a policy. As a result, the agent would open up a new policy in error. Not only was it taking up to two minutes for agents to find policy information in their CRM, they were often misinterpreting that policy information and erroneously creating policies at a significant cost each time.

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Finally, the client had obvious privacy concerns about agents not authenticating customers properly. According to privacy regulations, the organization could be held liable for agents incorrectly giving out any personally identifiable information which carried a fine of up to $2,500 per occurrence. Management felt there was no reason they shouldn’t be able to properly authenticate customers 100% of the time, thereby limiting the sensitive information that was shared with the wrong parties.

Further complicating these issues, the company’s legal department delivered a list of process changes that needed to be made just two weeks before open enrollment began. In order to remain in legal compliance, the contact center team would need to retrain 250 agents on a number of new processes—most of which allowed very little room for error—in preparation for the onslaught of calls that were coming with open enrollment.


The client implemented the Vistio solution to improve customer experience metrics while establishing a repeatable process for agents to handle calls without quality issues related to authentication or erroneous policy creation.

The Vistio team quickly built the client’s authentication and other processes into Vistio’s workflow tool so Vistio would show their agents exactly the right step to take in every customer service situation. During the authentication process, a Vistio workflow would now tell the agent what to ask and then, based on the customer’s answer, customize its next instructions according to the client’s authentication rules. Similar workflows were built to direct agents to the correct data in their CRM so they didn’t erroneously create new policies and to ensure agents remained in compliance with any legal requirements. And since the implementation was done by the Vistio team, it required very limited involvement from the client’s IT team, relying only on their subject matter experts to advise on the implementation.

CSAT % Improvement: 4+ point improvement over three months capturing 35% of the remaining possible CSAT score.


With Vistio’s step-by-step agent guidance, the client’s agents simply had to follow the on-screen prompts to ensure 100% authentication. They also no longer had to navigate their CRM to find customer data. Instead, the correct customer data was automatically displayed in Vistio, saving significant time and reducing the potential for error. Now, calls were handled exactly in accordance with the company’s policies and legal requirements, allowing agents to resolve inherent quality issues, reduce repeat calls, and improve first call resolution, all while achieving 100% authentication. Overall, average call handle time decreased by over two minutes and their quality scores improved by over 25%.

Quality Improvement: As proper use of Vistio increased, QA increased from 76% to 91% in 90 days.

The directors who were previously skeptical that Vistio could solve their authentication problem were now very impressed with its capabilities.

In the future, the client plans to continue innovating and to be on the forefront of technology and Vistio is at the heart of that strategy.They plan to integrate more of their systems with the Vistio solution, automatically providing their agents with more information on their screen rather than having them dig for it. They would also like to use Vistio’s communication tools to facilitate and optimize staff and management interactions. And finally, they plan to use Vistio’s intelligence tool to monitor agent performance in real time and to help them uncover agent issues that need to be addressed.

Increased CSAT Measure: The percentage of customers who rated service as Satisfied or Better increased from 81 % to 94%.

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