AI-first contact center,
built on HCSC’s data.
A working point of view on the future-state Customer Support Specialist desktop — tier-aware Benefits Navigator copilot, provider claims deflection, and an on-prem fine-tuned SLM that keeps PHI inside HCSC’s environment. Built to exercise the three targets: 700→350 headcount, 20→10 min AHT, 50% provider call reduction — and designed to sit on top of whichever contact-centre platform HCSC selects.
Sits above whichever contact-centre HCSC chooses
The AI layer demonstrated here is intentionally vendor-neutral. Whether the underlying CCaaS lands as Amazon Connect, Cisco Webex, Avaya, NICE CXone, or Genesys Cloud, the routing engine, copilot patterns, PHI protection, provider deflection, handoff, and force-ranker all sit above it via standard integration points (CTI screen-pop, transcription stream, knowledge APIs).
Scott’s three business goals don’t change with the platform decision. This POV gives the team a prioritised roadmap that’s safe to commit to now — and a working demo to anchor it to — without waiting on the CCaaS choice.
Six demos, one unified desktop.
CSS Copilot Desktop
Three-panel agent cockpit. Tier-aware so the specialist stops recommending out-of-tier providers — the failure mode that drives a chunk of the 20-minute call. Knowledge cards, dual-layer sentiment, supervisor escalation, three scripted scenarios.
Multi-Level LLM + SLM Routing
The 8-factor decision engine with live LLM calls. PHI triggers on-prem SLM; complex reasoning goes to frontier Claude. Healthcare example: eligibility, denials, prior-auth, appeals.
Provider Claims Deflection
NPI+TIN-authenticated conversational bot answering claim status, denial codes, payment, auth, and appeals directly from EDI 277 / 835 — same data HCSC already delivers.
PHI Detection & Redaction
Live pattern-based PHI scanning — SSN, member ID, claim #, NPI, MRN, DOB, ICD-10. Drives the privacy factor in the routing engine. Shows redacted forwarding output.
Zero-Repetition Handoff
AI-generated handoff packet at transfer — context summary, what's been said, what's next, sentiment carry-over, drafted opener. Three transfer types: tier-1 → supervisor, member → provider line, bot → human.
Opportunity Force-Ranker
12 candidate initiatives × 7 scoring factors with adjustable weights. Live re-ranking, per-row Claude rationale, copy-as-Markdown export. Designed for the Day-2 prioritisation session.
Built on the Bounteous accelerator library
We compress what would normally be months of foundational work into focused, HCSC-shaped weeks by drawing on a library of proven CX-AI accelerators we maintain across enterprise engagements. Each piece below is shipped as a tested building block — we adapt the healthcare vocabulary, plug in HCSC content, and re-theme to the BCBS visual language.
- • Three-panel agent desktop pattern
- • RAG knowledge backend with vector search
- • Dual-layer sentiment + escalation prediction
- • Multi-pattern PHI detection & redaction
- • Zero-repetition call handoff
- • 8-factor SLM-vs-LLM routing engine
- • Domain fine-tuning pipeline (LoRA on small models)
- • Provider-channel self-service framework
- • Root-cause & upstream-driver analytics
- • Opportunity force-ranker
On the fine-tuned SLM: the prototype demonstrates an HIPAA-aligned, on-prem fine-tuning pattern (Mistral-7B + LoRA) so PHI never leaves the environment. HCSC-specific retraining on plan documents and policy PDFs is the straightforward production next step using the same pipeline.
Don’t just deflect calls — eliminate the reasons they happen
The same transcript and disposition data the AI Layer reads to power copilot suggestions also surfaces the upstream business processes generating the call volume in the first place — for example, “22% of post-enrolment calls in March were about missing ID cards: the onboarding mailer mis-fires for groups added between the 15th and 30th.” Bringing this back to Operations turns AI from a contact-centre cost lever into an enterprise improvement signal — and is one of the workshop opportunities to force-rank.