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AI-powered member support: Built for real conversations, ready when members need it

A closer look at how AI is transforming the contact center experience, delivering faster answers, helping reduce friction and helping members move forward with greater confidence.

By Leah Groos, Senior AI Product Manager, Optum Financial | September 21, 2026 | 5-minute read

From hold times to real-time support: Reimagining the contact center

For many members, reaching out for support still means long wait times, repeating information and leaving without clear next steps.

That experience is beginning to shift. With AI, the contact center is evolving into a more responsive, real-time support model that is available whenever members need it, already supporting millions of interactions.

Instead of reacting after issues arise, this approach aims to guide members in the moment — so they can understand their benefits, take action and move forward with less effort.

What powers a smarter support experience

At the center of this model is a combination of conversational AI and human-centered design, working together to support a more intuitive and efficient support journey.

Three ways this comes together

Always-on, conversational support

Members can access voice support at any time. The experience is designed to reflect how people naturally speak, making it easier to get answers without navigating complex prompts or waiting on hold.

Guided resolution from start to finish

Common needs such as balance checks, eligibility questions or card activation can be handled in a single interaction, supporting members in quickly completing what they came to do.

Seamless connection to human support

When an issue requires additional help, the transition to a live agent is smooth. Context carries through, so members are rarely asked to repeat information they have already shared.

Personalization at scale: Turning questions into confident decisions

Delivering meaningful support across millions of interactions requires more than automation. It depends on understanding each member’s situation and responding accordingly.

AI helps make that possible by identifying where someone is in their journey and working to tailor guidance to fit that moment. Whether the need is clarification, a next step or a quick answer, the experience adapts in real time.

Rather than receiving generic responses, members are met with guidance that feels relevant and actionable. Over time, this can reduce confusion and help build confidence in using their benefits.

Designed for real-world member needs

This solution was shaped by studying how members actually communicate, including the language they use, the questions they ask and how they describe their needs in everyday situations.

Those insights show up in an experience that is:

  • Approachable with simple language and clear, easy-to-follow guidance
  • Continuously working to improve as interactions inform ongoing refinements
  • Informed by human expertise through active review and optimization

Balancing AI and human expertise

Speed and scale are important, but they are only part of the equation. A strong support experience also depends on thoughtful design and human oversight.

The role of AI is to strengthen that experience. It surfaces insights, simplifies complex information, and helps care teams route members to the right level of support when needed.

By working together, AI and human expertise create interactions that feel clear, consistent, and easy to act on.

Results that reflect real impact

Early outcomes demonstrate meaningful improvements across both the member experience and operational performance:*

  • Over 10 million calls handled since launch
  • 74% self-resolution rate, reducing the need for transfers and wait times

These results highlight a broader pattern. When support is easier to access and more relevant to the individual, members may be more likely to engage and take action.

Why it matters for plans and members

At its core, this evolution helps simplify one of the most complex parts of the member experience.

For plans and partners, it can help deliver:  

  • Greater operational efficiency
  • Reduced call center demand
  • Improved member satisfaction

For members, it’s designed to deliver: 

  • Faster answers with fewer barriers
  • Clear next steps and more guided support
  • A more confident, less stressful experience

Looking ahead: A more connected support ecosystem

This is only the starting point.

As AI capabilities continue to advance, the planned opportunity is to connect support, guidance and decision-making more seamlessly across the member journey. Each interaction becomes part of a broader, more cohesive experience.

The focus remains the same: try and make it easier for members to get timely, reliable answers and move forward on their health care questions with confidence.

   

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*Since March 2026 launch

About Optum Financial

Optum Financial helps organizations simplify health benefits and connect health care with financial experiences. Through health benefit accounts, payment solutions and supplemental benefit capabilities, Optum Financial supports health plans, employers and members with tools designed to make benefits easier to understand, use and manage.