From Complaints to Measurable CX Gains

Healthcare plan service teams were dealing with:

• Recurring complaint themes (same issues coming back week after week) with no clear prioritization of what to fix first
• Inconsistent interactions across agents, leading to avoidable dissatisfaction
• Operational pain points like unclear handoffs, fragmented knowledge, and uncertainty in “next steps”
• CSAT stuck in the low 60s, fluctuating with the same unresolved drivers

We used Atento AI Studio to connect three elements into one operating loop: insights → action → measurement.

The AI Studio process

1. Identify opportunities (where to focus)
   • Clustered and ranked customer complaints to isolate the highest-impact drivers of dissatisfaction
   • Split opportunities into two action tracks: People (agent behaviors) and Process (operational friction)
2. Create prompts (to go deeper and get specificity)
   • Built targeted prompts to extract root causes behind complaint categories
   • Generated recommendations tied to real interaction patterns and operational gaps
   • Produced outputs in operator-ready language (clear, practical, easy to implement)
3. Translate insights into operational actions (make it usable)
   • Converted findings into frontline protocols, training topics, knowledge updates, and process changes
   • Created a repeatable playbook so teams could apply the same method to new complaint spikes
4. Accompany applicability and results (ensure adoption and impact)
   • Partnered with operations to validate feasibility, implement changes, and track adherence
   • Monitored early performance signals and refined prompts/actions based on what moved the numbers

What the client received was not a report, but a practical action system.

People (frontline execution)

• Targeted coaching and training tied to the biggest complaint drivers
• Standardized service protocols (opening, investigation, confirmation, closure) to reduce variability
• Feedback loops using real interaction examples to reinforce behaviors that improve trust
• Support guidance for sensitive conversations to reduce escalation and frustration

Process (operational consistency)

• Updated knowledge base / support materials based on customer language and recurring confusion
• Clearer inter-area communication routines to reduce handoff failures
• Restructured operational playbooks so agents find “next best action” faster
• FAQ creation driven by real complaint themes, not assumptions

• CSAT increased from the low 60s to the mid-70s
• That shift reflects a ~19% improvement (roughly a +12-point gain), driven by:
  • More consistent agent behaviors (less variability, fewer “missed” steps)
  • Clearer answers and better ownership of the request
  • Faster resolution paths enabled by updated knowledge and workflows