AI Makes People Skills The Differentiator In Health Plan Contact Centers
The teams that perform best in hybrid health plan contact centers are those with the people skills and interpersonal strengths to make human moments count.
People Now Handle What AI Can’t. That’s Where Health Plans Win Or Lose.
Health plans are automating routine interactions. What’s left are the harder, emotionally complex, higher-risk calls. These challenging situations now define performance.
AI Took The Simple Stuff
Bots can explain deductibles. What’s left for reps? Calls from members facing denied coverage. Caregivers trying to navigate confusing benefits. Frustrated policyholders ready to leave.
These situations demand emotional intelligence, thoughtful decisions, and the ability to remain composed.
As McKinsey notes:
“Complex requests often require the empathy and judgment that only humans can provide.”
Performance in these moments drives business-critical metrics. For example:
- J.D. Power scores include human interaction and problem resolution.
- CMS Star Ratings assess access, responsiveness, and support from contact center reps.
The Numbers Backed Up Embedding AI
Harvard Business School found that AI support improves both speed and empathy. With AI by their side, agents respond faster, provide more complete answers, and show more empathy.
These benefits are most pronounced among newer employees, who gain structure and guidance from well-designed AI tools.
The implication: AI is not replacing people. It is raising expectations.
Health plan operations teams must meet higher standards in judgment, communication, and service quality. Even regulators reinforce this. CMS monitoring requires representatives to respond to inquiries within 7 minutes. Timeliness alone isn’t enough. Clarity and empathy are also essential. As Andrea Willis, MD and SVP at BlueCross BlueShield of Tennessee, said, “We must never lose sight of the human experience.”
Now, Health Payer Leaders Are Prioritizing Human-Centered Capabilities
Becker’s Healthcare recently highlighted 17 underrated skills that payer executives say they need more of, because these skills influence member satisfaction, loyalty, and compliance.
The list of underrated skills includes:
- Big‑picture thinking, advocated by Abdou Bah, Chief Health Equity Officer at EmblemHealth. “Enlarging the aperture of focus is the key to true population health management,” Bah said. He described how disease prevention requires assessing what wasn’t working and why, and then responding accordingly.
- Systems thinking, emphasized by Hillary Galyean, Chief Growth Officer at St. Luke’s Health Plan. “Every payer decision impacts care delivery, provider workflows, and ultimately, patient outcomes,” she said. Gaylean noted that thinking across silos is essential for alignment and sustainable value.
- Change management and honest communication, were identified by Chris Gay, CEO at Evry Health, as underrated skills within health insurance. Gay said payer leaders must “move from cost‑shifting to care‑investing, while having honest and hard conversations with the public.” He underlined that rebuilding trust depends on clear, forward‑looking narratives.
- Wisdom, added by Krischa Winright, President, Medicare Advantage at Blue Cross Blue Shield of Michigan. As the Medicare Advantage market rapidly shifts, she said the balance between near‑ and long‑term priorities becomes “absolutely critical” — especially when navigating accelerating changes enabled by AI and other technologies.
The capabilities cited by payer executives show up in every unresolved claim, confusing benefit explanation, or frustrated member call. Contact centers are where these gaps become operational problems: repeat calls, dropped satisfaction scores, early attrition. And they’re where the fix starts.
Health plans that build these skills into their frontline teams see better results across J.D. Power, CAHPS, and CMS measures. They’re also better equipped to adapt as AI changes how service is delivered.
Even During The AI Era, Human Capability Is A Performance Lever
Top-performing teams are equipped to handle complexity. In a contact center environment shaped by automation, human skills determine how effectively issues are resolved, how quickly trust is rebuilt, and how often problems stay solved.
That’s why organizations that invest in frontline capability are seeing returns in 3 places:
- Member Satisfaction: Members report better experiences when reps resolve issues clearly and calmly.
- Associate Retention: Agents with structured coaching are less likely to quit in the first 90 days.
- Compliance: CMS monitoring favors timely, accurate, human responses.
Human capability is not just about being “human-centered.” It’s about reducing rework, risk, and reputation damage at scale.
AI Raised Expectations. Prepare Your Team To Meet Them.
The future of health plan contact centers is hybrid: technology handles the routine, while people manage complexity. The teams that perform best are those with the skills and interpersonal strengths to make those human moments count.
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