The regulatory constraint
The agent operates entirely inside the PHI boundary, and any request touching a coverage determination routes to a qualified human reviewer.
How we work in this industrySituation
The internal service desk absorbed roughly 14,000 tickets a month across access, benefits and policy questions. Average handle time held at 11 minutes, but headcount was frozen and volume was growing 9% year over year.
A previous vendor's proof-of-concept had run for eighteen months in a sandbox, never integrated with ServiceNow, and was retired without a single production ticket resolved.
Approach
Month one: workflow mapping against the real escalation path rather than the documented one, plus system access, security review, and agreed success criteria.
Month two: an agentic domain system deployed into the live ServiceNow environment, arriving pre-built for the service-desk domain and configured to the client's integration surface.
Month three: side-by-side demonstration against the human baseline, runbooks, and transfer of operational ownership, with Managed Services retained for the expansion backlog.
What we built
- Autonomous resolution for the six highest-volume Tier-1 request types, covering 62% of inbound ticket volume.
- Real-time agent assist surfaced inside the existing ServiceNow console — no new tool for agents to learn.
- Auto-summarization and routing for every ticket the agent escalates to Tier 2.
“We spent eighteen months and a seven-figure budget on a demo that never left the sandbox. This one was answering real member-services tickets before the quarter closed.”
Director of Enterprise Service Management — national health plan