Contact Centers Reimagined: Supporting Payers and Providers in a Complex World
With rising expectations, seamless integration and automation are no longer optional—they’re essential.
By Angie Lanasa, Senior Vice President of Operations, Imagenet
Healthcare contact centers are the front line of communication for payers, providers, and members. Members want fast, clear answers about benefits and eligibility, while providers rely on accurate updates about claims, prior authorizations, and reimbursement timelines. For payers, these interactions shape satisfaction scores, influence network relationships, and directly impact administrative costs.
As regulatory requirements shift more frequently and there are more complex high-deductible plan types added into the fold, even small mistakes can have outsized operational and financial consequences. Recently, the American Customer Satisfaction Index again found that healthcare contact center satisfaction was among the lowest-ranked categories in several industry choices that also included quality and reliability of plan mobile apps, prescription drug coverage, and timeliness of claims processing.
A delayed answer, an unclear explanation, or a poorly routed call quickly creates frustration that can impact clinical or financial outcomes—or, both. This pressure is driving many organizations to rightfully cast a brighter spotlight on their contact center operations.
The Hidden Challenges Inside Modern Healthcare Contact Centers
Even with strong internal teams, many healthcare organizations face recurring challenges. One of the most common issues is relying on generalist agents who lack the depth of healthcare knowledge required to handle complex inquiries. Without familiarity in claims processing, prior authorization steps, medical terminology, or network rules, agents often need to escalate calls or transfer members and providers to specialized teams. This not only prolongs the experience, but also diminishes trust—trust that is at a three-year low, according to Forrester.
Another common contact center challenge stems from disparate systems that aren’t fully interoperable. Many centers are still juggling multiple legacy platforms, toggling between claims systems, imaging tools, eligibility databases, and provider directories. This increases the likelihood of inaccurate answers, and call times that stretch beyond the best practice of seven to eight minutes considered the gold standard by HFMA. When an agent can’t see the full member or provider journey—including previous interactions, submitted documentation, and claim history—the call becomes repetitive and frustrating for all parties.
Reducing Provider Abrasion Through Better Support
Provider abrasion has become a priority for payers, especially as networks expand and administrative tasks multiply. A provider who encounters long wait times, conflicting answers, or unclear guidance is more likely to submit incorrect documentation, file appeals, or escalate complaints. This drives up costs across the ecosystem.
The path toward reducing abrasion begins with support built specifically for provider needs —especially around coding, billing, and reimbursement workflows. It’s also crucial to improve first-call resolution rates. When support teams have integrated systems and specialized training, providers can receive complete answers without being transferred to multiple departments. This specialized training should be complemented with consistent communications, with structured scripting and well-defined instructions for the most common areas of abrasion that are identified through advanced analytics.
What Today’s Payers Need: Integration, Insight, and Industry Expertise
For payers and providers, contact centers are no longer just transaction hubs—they’re relationship hubs. A single positive experience can strengthen loyalty, while a poor one can create friction that ripples across an entire operation. That’s why it’s imperative to find a partner with decades of experience in solution areas like claims, digital mailrooms, and member communications and reconciliation. That breadth of insight allows for more consistent, accurate, and efficient responses—something today’s callers demand and tomorrow’s regulations will require.
One of the most meaningful opportunities for improvement lies in the technology foundation that supports contact center teams. The right integration strategy creates a unified view across eligibility, claims, documentation, provider data, and member interaction history. When these systems speak to each other, agents can resolve questions more quickly, avoid duplicative steps, and reduce the “information chase” that drives repeat calls. It’s not just a technology upgrade; it’s an experience upgrade.
Automation plays a similarly important role, complementing integration and skilled staff. Modern contact center workflows benefit from automating repetitive tasks—such as validating claim status, pulling up relevant documents, or routing requests to the appropriate team. When automation handles the predictable, agents have the bandwidth to focus on more complex or sensitive interactions. This shift also helps contact centers scale staffing levels more effectively, particularly during seasonal surges tied to open enrollment or claims volume spikes. The combination of integration and automation ultimately supports a more consistent and reliable experience for both members and providers.
The Future of Contact Centers: Purpose-Built for Healthcare
The future belongs to contact centers that are purpose-built for healthcare: trained personnel with specialized industry knowledge, integrated technology ecosystems that eliminate friction, and workflows enhanced by intelligent automation.
The healthcare contact center is no longer a simple service function—it is a core part of the payer and provider experience. Those who invest in modern, healthcare-focused contact center solutions will be better positioned to reduce provider abrasion, elevate member satisfaction, and operate with greater accuracy and efficiency.
If integration, automation, and healthcare-trained agents are part of your organization’s transformation goals, see how Imagenet has already delivered measurable improvements for other leading health plans here.