Health Services Organization Case Study

Scaling Complex Healthcare Services Without Sacrificing Quality or Control

 

How a leading Medicaid health plan partnered with Working Solutions to stabilize operations, improve performance and redefine success in healthcare customer support.

 

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4.5+
Customer Satisfaction Score (CSAT) 
Sustained every month post-ramp (out of 5)
22%
Health Risk Assessment Tool (HRAT) Completion
 47% improvement over historical benchmark 
95%–120%
Staffing Adherence 
Consistently exceeding targets
<1 Second
Speed to Answer 
As low as 0.08 seconds
30%
Reduction in Handle Time 
While increasing call-handling complexity 

Transforming Healthcare Contact Center Operations at Scale

A leading Medicaid and health services organization faced increasing operational pressure across multiple programs. Rising member demand, complex service requirements and underperforming outsourcing partners created risk across quality, access and internal capacity.

Working Solutions partnered with this US-based healthcare provider to stabilize operations, redesign workforce delivery and scale support across highly complex healthcare services.

The result: Not just improved performance, but a fundamental shift in how this organization defines success in contact center outsourcing.

The Challenge: Complexity Without Control

Before Working Solutions, a leading Medicaid health plan faced systemic breakdowns across its outsourced contact center operations:

  • Inconsistent staffing and scheduling models 
  • Declining quality driven by ineffective agent training
  • High attrition and low agent readiness
  • Limited scalability across multiple lines of business
  • Vendor complacency and lack of accountability
open-enrollment-2

These issues created compounding operational strain, making it difficult to maintain consistent service levels and support growing member demand.

At the same time, the organization needed a partner capable of:

  • Rapidly absorbing volume
  • Supporting multiple complex programs simultaneously
  • Maintaining quality in a highly regulated healthcare environment

Traditional BPO models were not delivering.

growing-member-demand

The Turning Point: Rethinking the Outsourcing Model

After continued underperformance from traditional vendors, this healthcare organization revisited the Working Solutions model with a need for a fundamentally different approach.

What initially felt unfamiliar compared to traditional BPO structures became a clear opportunity to rethink how workforce delivery, training and operational ownership could work together more effectively.

Working Solutions introduced a high-performance model built on:

Flexible, independent contractor workforce

Flexible, independent contractor workforce

Demand-based scheduling versus fixed shifts

Demand-based scheduling versus fixed shifts

Deep investment in education and enablement

Deep investment in education and enablement

Operational ownership, not just execution

Operational ownership, not just execution

This shift enabled a more adaptive, scalable approach to supporting complex healthcare programs, setting the foundation for improved customer experiences (CX) and long-term partnership.

The Solution: Flexible Workforce + Deep Enablement

Workforce Flexibility That Eliminates Operational Burden

Working Solutions removed traditional workforce management constraints by introducing a more adaptive, demand-driven model:

  • No rigid schedules
  • No manual break or coverage planning
  • Real-time alignment to member demand
sympathetic-agent

The Impact

Continuous service coverage, even during internal events such as companywide trainings or team-wide meetings that would typically reduce available staff
Continuous service coverage, even during internal events such as companywide trainings or team-wide meetings that would typically reduce available staff
No backlog or post-event recovery surge
No backlog or post-event recovery surge
Reduced administrative burden on internal workforce management teams
Reduced administrative burden on internal workforce management teams

By removing the need for manual scheduling oversight and rigid staffing structures, the healthcare provider could maintain consistent service levels while alleviating operational strain on internal teams.

Education as a Strategic Advantage

Healthcare complexity demands more than standard onboarding. It requires a structured, consultative approach to training that evolves with program needs and call complexity.

Working Solutions implemented a tailored education model designed to support multiple lines of business while maintaining consistency and quality:

  • Dedicated subject-matter experts aligned to each program.
  • Concurrent training across multiple lines of business, enabling teams to support diverse member needs without disruption.
  • Simulation-based learning to mirror real-world member interactions.
  • Progressive, call-complexity training that builds capability over time.
Focused student takes a test online in a studious environment

The Impact

Faster agent readiness across programs
Faster agent readiness across programs
Higher retention driven by confidence and support
Higher retention driven by confidence and support
Improved quality and consistency from day one
Improved quality and consistency from day one

This approach positioned training not just as onboarding, but as an ongoing operational advantage. Ensured teams were continuously prepared to handle evolving healthcare demands with accuracy and confidence.

Built for Complexity and Continuous Change

This large regional healthcare organization operates in a dynamic environment requiring:

  • Frequent system and workflow updates (including customer relationship management system and compliance changes)
  • Multiple service lines with distinct requirements
Competent and educated customer service agent talks a customer through the steps of her service in the comfort of her own home

Working Solutions delivered a model designed to adapt in real time:

Dedicated program teams aligned to each line of business
Dedicated program teams aligned to each line of business
Continuous retraining and performance optimization
Continuous retraining and performance optimization
Technology-enabled quality assurance and coaching
Technology-enabled quality assurance and coaching

With the improvements, teams could quickly adapt to evolving systems, processes and regulatory requirements without disrupting service quality or member experience.

Scalable by Design

The partnership was built to scale quickly and efficiently as demand evolved:

  • Launched with two programs and expanded across multiple complex lines of business.
  • Seamlessly supported seasonal Medicaid surges and fluctuating demand.
  • Rapidly increased capacity without compromising quality or service levels.
scalability-on-demand

As a result, the organization scales hours and staffing in real time. It also handled meeting significant volume increases with speed, flexibility and operational consistency.

The Results: Performance That Redefined Expectations

  • 4.5+ CSAT sustained consistently post-ramp

  • Ongoing performance improvement beyond initial onboarding

With Working Solutions help, the healthcare provider delivered consistent, reliable performance month over month, establishing a new standard for quality and accountability.

  • 47% increase in Health Risk Assessment (HRA) completion rates (from ~15% to ~22%)

Driven by:

  • More effective timing and targeting of member outreach

  • Flexible workforce alignment to demand and program needs

These improvements not only increased program effectiveness but also elevated overall performance expectations across key operational and health outcome metrics.

  • 95%–120% schedule adherence (vs. 90% target)
  • 95%–100% service levels (vs. 80% target)
  • Less than 1 second average speed to answer

This reflects consistent, enterprise-grade performance across programs, even under fluctuating demand.

  • ~30% reduction in average handle time (AHT) over time
  • ~25%–30% reduction in after-call work (ACW) through process optimization and AI-assisted workflows
  • Faster resolution across complex and multi-step member inquiries

These gains reduced cost-to-serve while improving overall service efficiency and consistency.

 

  • Agents trained to handle higher-complexity and escalated (Tier 3) interactions
  • Consistent performance across complex claims and regulated healthcare scenarios

The organization now relies on a more capable, flexible workforce able to manage advanced member needs without additional escalation layers.

 

Customer Experience

  • 4.5+ CSAT sustained consistently post-ramp

  • Ongoing performance improvement beyond initial onboarding

With Working Solutions help, the healthcare provider delivered consistent, reliable performance month over month, establishing a new standard for quality and accountability.

Health Outcomes

  • 47% increase in Health Risk Assessment (HRA) completion rates (from ~15% to ~22%)

Driven by:

  • More effective timing and targeting of member outreach

  • Flexible workforce alignment to demand and program needs

These improvements not only increased program effectiveness but also elevated overall performance expectations across key operational and health outcome metrics.

Operational Excellence

  • 95%–120% schedule adherence (vs. 90% target)
  • 95%–100% service levels (vs. 80% target)
  • Less than 1 second average speed to answer

This reflects consistent, enterprise-grade performance across programs, even under fluctuating demand.

Efficiency Gains

  • ~30% reduction in average handle time (AHT) over time
  • ~25%–30% reduction in after-call work (ACW) through process optimization and AI-assisted workflows
  • Faster resolution across complex and multi-step member inquiries

These gains reduced cost-to-serve while improving overall service efficiency and consistency.

 

 

Agent Capability

  • Agents trained to handle higher-complexity and escalated (Tier 3) interactions
  • Consistent performance across complex claims and regulated healthcare scenarios

The organization now relies on a more capable, flexible workforce able to manage advanced member needs without additional escalation layers.

From Vendor to Strategic Partner

The partnership evolved beyond execution into a strategic extension of the organization’s operations:

Trusted by both leadership and frontline teams
Trusted by both leadership and frontline teams
Integrated into ongoing operational planning and decision-making
Integrated into ongoing operational planning and decision-making
Influencing internal training approaches and KPI strategy
Influencing internal training approaches and KPI strategy

The healthcare provider today can focus on its core mission by delivering consistent, high-quality member support, creating alignment between operational execution and broader organizational goals.

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Why Working Solutions Delivers in Healthcare

Flexible Workforce Model

On-demand scalability without operational burden

Flexible Workforce Model

Education-First Approach

 Training designed for healthcare complexity, not volume alone 
Education-First Approach

Built for Healthcare

Compliance-aware expertise across multiple service lines and member programs

Built for Healthcare

Operational Partnership Model

Proactive, consultative partnership with shared accountability for performance and outcomes

Operational Partnership Model

The Bottom Line

As a best-practice outsourcer, Working Solutions enables healthcare organizations to:

  • Scale complex services quickly.
  • Improve quality and consistency.
  • Reduce operational burden.
  • Deliver better outcomes for members.

In one sentence:

Working Solutions streamlines the operational complexity behind healthcare delivery so organizations can focus on what matters most, serving their members.

Exuberant educator runs through list of priorities with Working Solutions PRO

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Who We Are

Working Solutions provides virtual contact center outsourcing that measurably improves customer experiences (CX). We deliver high-quality, all-encompassing solutions for your fluctuating sales and service needs. Our on-demand CX expertise enables you to better engage, empathize with and delight customers, wherever and whenever they interact with your brand.