Case Study: UPMC Health Plan achieves proactive, personalized member care and service excellence with Genesys

UPMC Health Plan Optimizes Customer Conversations to Ensure Service Excellence

UPMC Health Plan, the second-largest insurer in western Pennsylvania, needed to stand out in a competitive market while managing 1.2 million inbound calls a year and serving more than 115,000 Medicare members—many elderly or with complex needs. The organization’s challenges included delivering consistent, personalized service, achieving one-call resolution, proactively reaching at-risk members, and replacing manual spreadsheet-based reporting to better track performance and outcomes.

UPMC deployed Genesys’ customer interaction platform and created a Health Care Concierge Program that routes members to a dedicated concierge, enables real-time agent access to member data, supports chat and outbound campaigns, and collects immediate survey feedback. The result was higher member satisfaction and retention (over 8% enrollment growth), industry recognition (J.D. Power, NCQA, ICMI), improved operational efficiency and real-time metrics, doubled chat volumes, fewer inbound calls due to proactive outreach, and numerous documented cases of improved—and sometimes life‑saving—member outcomes.

UPMC Health Plan

Mary Beth Jenkins

COO, UPMC Health Plan