Omnichannel and CRM flow
Channel ingress to governed response and QA evidence
Human escalation remains available at every step. Policy gates decide what the AI can see, suggest, write,
and archive.
Channels
Voice, IVR, chat, secure message, portal event
Metadata, transcript stream, intent, authentication state, routing context.
Queue routing
Skill, language, sentiment, plan, urgency, and escalation policy.
Intelligence
Conversation orchestrator
State machine, confidence threshold, tool policy, handoff trigger.
RAG retrieval
Benefits docs, claim policy, scripts, employer plan knowledge, source citations.
Systems
CRM and case platform
Member profile, prior contacts, tasks, notes, disposition, service history.
Core APIs
Eligibility, claim status, enrollment, payment, document status, provider data.
Assurance
Response guardrails
PII redaction, approved language, confidence, source validation, action limits.
QA automation
Transcript scoring, compliance flags, coaching queue, knowledge gap capture.
Telemetry
Operational signals
Quality, handle time, resolution, escalation, latency, cost, adoption, overrides.
Model monitoring
Drift, hallucination, unsafe answer, fallback rate, source freshness.