At Becker’s 15th Annual Meeting, leaders from Microsoft and Blue Shield of California shared how AI is one tool to help transform payer operations — not by replacing humans, but by personalizing care, cutting friction and restoring trust.
Christine McKinney, vice president of customer experience and digital transformation at Blue Shield of California (Oakland) emphasized the strategic use of AI as both a data enabler and an engagement enhancer.
Here are five key takeaways from the session:
1. From voice to value: Fixing the call center
For McKinney, call centers are often the first point of contact for consumers and can shape their expectations. Blue Shield was seeing declining first-call resolution rates, with certain call types repeatedly resurfacing.
To improve efficiency for both staff and customers, McKinney partnered with Microsoft to better analyze existing data sets and identify connections that had previously gone unnoticed.
“We were able to understand the different use cases that we really needed to prioritize because we know we want to build a long-term relationship with our members,” Ms. McKinney said. “That was a great opportunity for us to help the member experience and reduce repeat calls because if a member has to call more than once that’s going to increase their frustration and add costs.”
Their AI-enabled process now flags calls needing quality review, allowing managers to prioritize coaching without manually reviewing hundreds of recordings. Early use cases have shown potential efficiency gains of 25% to 50% by combining human expertise with AI precision.
2. Welcome done right: Personalized onboarding
New members are often vulnerable to confusion and dissatisfaction. That’s why Blue Shield collaborated with Microsoft to develop an AI-powered “experience cube,” designed to capture preferences and personalize each interaction from day one.
The onboarding strategy includes pre–Jan. 1 engagement, intelligent provider matching and long-term relationship building. With 87% of members willing to share information to personalize their journey, Blue Shield is able to tailor outreach at scale and improve member experiences.
“We’re not just trying to take a shotgun approach of sharing all of our benefits that we think might be valuable to them but aren’t valuable to them,” Ms. McKinney said. “We can’t do that unless we have that data and we have that conversation with the member so that we can learn.”
3. Creating a unified health record
Alongside the “experience cube”, Blue Shield is developing extensive member health records using Microsoft Azure. The platform aggregates claims, provider and payer data into a centralized hub.
McKinney estimates that roughly 1 billion records have been shared, enabling links to 25 care gap use cases. These are used to push personalized recommendations and improve care coordination across the continuum.
“What we’re doing is creating that one-stop shop for members so they can see where their care is and where their care is going,” Ms. McKinney said. “We want to guide them to the highest quality outcomes because that’s really where we see the win-win for our members and our plan.”
In addition to centralized data and AI guidance, Blue Shield is reimagining the chatbot — moving from basic call deflection to more advanced digital engagement.
“We want members to be able to be successful and self-serve through our digital channels,” Ms. McKinney said. “If you do it right, if you have the right conversational tools, you can really be successful in that chatbot strategy.”
McKinney sees chatbots evolving from transactional to conversational tools. Blue Shield is also equipping contact center representatives with generative AI to simulate expertise and deliver personalized guidance in real time.
Blue Shield always takes a thoughtful approach to AI, and enterprise-wide education and trust in data have enabled McKinney’s team to fully leverage the technology. A systematic review of how data is accessed, what processes involve AI and how cases are handled has led to a prioritization framework aligned with cost, quality and experience goals. “The beauty is that technology is going to help get us there,” McKinney said. “But you’re still going to need that human centered approach to make sure that you’re still delivering it in a way that’s very meaningful to the member.”
