33% AHT reduction on eligibility calls at a Medicaid MCO — contact center modernization
A state Medicaid MCO was running eligibility and enrollment on an aging Cisco estate with no agent assist and a queue of state audit findings. pronix.ai moved them to Genesys Cloud with Kore.ai agent assist and Health Cloud integration — 33% AHT reduction, clean audits, and a modernization path for the rest of the estate.
State Medicaid MCO, 900 agents · Genesys Cloud CX · Kore.ai · Salesforce Health Cloud
- Client
- State Medicaid MCO, 900 agents
- Industry
- Health Payers
- Platform
- Genesys Cloud CX · Kore.ai · Salesforce Health Cloud
*Representative outcome; results vary by client, scope and platform configuration.
The challenge
State reviewers had flagged inconsistent eligibility answers and slow document intake. The MCO needed a modern platform, agent assist grounded on the current policy set, and a paper trail every reviewer could follow — inside a fixed state fiscal-year window.
Our approach
Grounded agent assist first
Shipped Kore.ai agent assist grounded on the current eligibility handbook on day one of Genesys go-live; retired three legacy quick-reference PDFs that were causing drift.
Health Cloud case spine
Every eligibility and enrollment interaction wrote to Health Cloud with the sanctioned reason code — the audit trail state reviewers had asked for.
Document intake on-platform
Moved fax and email intake into Genesys workitems, cutting the average document-to-decision time from 6 days to under 2.
Compliance in the delivery team
State compliance lead sat inside the pod, reviewing scripts and prompts weekly — no reopens at go-live.
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Genesys Cloud CX programs, delivered and measured
Architect flows, omnichannel routing, Genesys Cloud AI, WEM and CRM integration — delivered in regulated and high-volume environments.
Brief details →AI for member service, prior auth, claims and appeals
Member service, prior authorization, claims attachments, appeals and provider data — instrumented for STARs/HEDIS/CAHPS and CMS-0057-F.
Brief details →Illustrative case study. Scenarios, metrics, quotes and client details are representative composites based on Pronix engagements and industry benchmarks unless a named client is shown with written consent. Outcomes vary by client, scope, data quality and platform configuration. Nothing on this page is a guarantee, warranty or professional advice. See our Terms of Use for the full disclaimer.
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