Best of '25! AH086 - Balancing Technology and a Human Touch in Member Service, with Lisa Ellerhorst and Sonia Pettis

In this Best of '25! episode of the Astonishing Healthcare podcast, Lisa Ellerhorst (Sr. Director, Customer Care Operations) and Sonia Pettis (Manager, Customer Care Operations) discuss our approach to member care! Lisa and Sonia have been with Judi Health (Capital Rx) since 2020 and have helped Will Tafoya develop our unique contact center model from the ground up. Building on Episode 34 - Customer Care in Healthcare: Setting a Higher Bar, and the questions plan sponsors and benefits consultants often ask during the RFP process (Episode 84), this episode covers:Several of the most frequent reasons plan members call and how those questions are handled, including switching a prescription from retail to mail and vice versa, prior authorizations for GLP-1s, and more.How to navigate transitions and focus on quality care (over speed).What it takes to maintain a high level of customer satisfaction (99%) while handling a 50% spike in call volume year-over-year.The communication strategy used to educate members and help them navigate new offerings effectively.The role of AI and how agentic AI can support member care and free up our skilled, PTCB-certified reps to handle more complex issues.Future-proofing the service model and preparing for the 2026 welcome season.Related ContentPharmacy Benefits 101: Building an Award-Winning Call Center from ScratchAH017 - Pharmacy Benefits 101: Prior AuthorizationHow employers can take back control of unnecessary pharmacy spendingCapital Rx’s Customer Care Team Wins 5 Stevie® Awards for Customer ServiceWatch: Are Your Prior Authorizations Actually Working?For more information about Capital Rx and this episode, please visit Judi Health - Insights.