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Closing the Gap: How Better Communication Can Lead to Better Workers’ Compensation Outcomes

By Eileen Potter, VP of Insurance Marketing at Smart Communications

The challenges facing workers’ compensation organisations are not new, but they are becoming more difficult to manage. Increasing complexity, higher expectations, and operational pressures all share a common thread: communication.

Every claim involves multiple parties—injured workers, employers, healthcare providers, insurers, and regulators – who all need to exchange information. When communication is clear, consistent, and timely, claims are easier to manage, compliance is stronger, and workers feel supported. When it isn’t, problems multiply.

Here are five ways better communications and interactions can help workers’ compensation organisations in Australia overcome their challenges and deliver better outcomes.

1. Building Trust with Injured Workers

A workplace injury is often one of the most difficult experiences a worker will face. Confusion about claims processes only adds to their stress. Schemes such as icare NSW and WorkSafe Victoria have recognised this by placing greater emphasis on providing clear, plain-language communication.

Regular updates, written in accessible terms and delivered through the worker’s preferred channel—whether digital, phone, or post—help them feel informed and supported. This trust makes it easier to secure cooperation with treatment plans and return-to-work programs, ultimately reducing claim duration.

2. Enhancing Collaboration Among Stakeholders

Effective collaboration is essential. In Queensland’s WorkCover scheme, for instance, case managers must coordinate with employers, GPs, specialists, and rehabilitation providers. Without reliable communication channels, information gets stuck in silos, leading to delays.

Modern tools can ensure that updates are automatically shared, documents are securely exchanged, and progress is visible to all relevant parties. This reduces duplication, eliminates confusion, and helps keep everyone focused on supporting recovery.

3. Strengthening Compliance

Each state regulator has its own reporting requirements, timeframes, and service standards. For example, ReturnToWorkSA sets out strict deadlines for employer notifications, while WorkSafe WA has its own set of obligations.

By standardising and automating key communications—such as notices of liability, requests for medical evidence, or employer reminders – organisations can ensure they remain compliant without adding extra administrative load. Tracking and audit features also make it easier to demonstrate compliance during regulator reviews.

4. Improving Operational Efficiency

Outdated systems often force case managers to spend time on low-value tasks, such as printing letters, chasing signatures, or entering the same information into multiple platforms. By digitising and streamlining communications, staff can focus their attention on the aspects of claims management that truly require human judgment and empathy.

For example, sending real-time SMS or email updates instead of letters can save days in delivery time, reduce inbound queries, and free up case managers to provide more personalised guidance.

5. Supporting Better Outcomes

Ultimately, better communication is about outcomes. Injured workers who receive clear, supportive information are more likely to follow treatment plans and return to work safely. Employers who are well-informed are better able to meet their obligations. Regulators see fewer compliance breaches and more accurate reporting.

Across schemes like icare NSW, WorkSafe Victoria, and WorkCover Queensland, the benefits of stronger communication ripple outward: reduced disputes, faster recovery, and more sustainable schemes overall.

A Stronger Foundation for the Future

Communication is often seen as a step in the claims process, but in reality, it is the backbone of the entire system. Every claim, every stakeholder, and every outcome depends on the quality of the interactions that take place.

By making communication more transparent, consistent, and efficient, workers’ compensation organisations in Australia can close the gap between current challenges and future goals – helping workers recover, supporting employers, and fulfilling their obligations to regulators and the wider community.

To learn more about this topic, or speak to experts in the field, come see us at the PIEF 2026 conference on October 25th.

 

Five Pressures Facing Australia’s Workers’ Compensation Organisations

By Eileen Potter, VP of Insurance Marketing at Smart Communications

Workers’ compensation organisations across Australia operate in a dynamic and highly-regulated environment, balancing the needs of injured workers, employers, healthcare providers, and regulators. At their best, they provide fair and timely support for workers while helping employers meet obligations and return people to safe and productive work.

But the pressures are mounting. New regulatory demands, rising customer expectations, and outdated processes are all converging to make this work more complex. Many organisations are finding it difficult to deliver the level of transparency, speed, and empathy that each stakeholder expects.

Below are five of the most pressing challenges currently facing workers’ compensation organisations in Australia.

1. Rising Claim Complexity

A single injury claim involves multiple stakeholders – the number of which depends on the severity of the injury. The parties involved include the employee, the employer, and one or more healthcare providers, but can also involve a case manager and the regulator. Coordinating this web of stakeholders is never simple. Each party requires different information at different times, and delays or missing details can quickly slow down progress.

For example, a worker may provide medical certificates late, an employer may misunderstand their obligations, or a rehabilitation provider may need additional documentation before treatment can begin. Small delays can add up, resulting in longer claim times, slower recovery, and increased costs for the scheme.

2. Growing Expectations for Transparency and Support

An injured worker is already under stress – physically, financially, and emotionally. They need clear and compassionate communication about what happens next, how long the process might take, and what is expected of them.

Employers, too, expect better visibility into the status of claims and guidance about their responsibilities. Yet many organisations still rely on outdated systems and manual communication processes. Letters are mailed days after decisions are made, or claimants need to call for updates because digital channels aren’t being used effectively.

The result is a mismatch between expectations and delivery, which can erode trust in the system.

3. Compliance and Regulatory Demands

Workers’ compensation is tightly regulated, but requirements vary across states and territories. For example, claims managers in New South Wales must comply with icare’s strict service standards, while in Victoria, WorkSafe’s guidelines set a different framework.

Frequent regulatory updates make it difficult for organisations to stay aligned, particularly when communications are handled manually. A missed deadline or incorrectly worded notice doesn’t just create delays – it can trigger compliance breaches and damage organisational credibility.

4. Operational Inefficiencies

Despite the push towards digital transformation in many industries, workers’ compensation still often relies on paper-heavy workflows and siloed systems. Case managers spend valuable time rekeying data, chasing missing forms, or responding to repetitive enquiries from injured workers and employers.

This not only drives up costs but also leaves less time for staff to provide meaningful, personalised support to those navigating the claims process.

5. Pressure to Improve Return-to-Work Outcomes

Governments and regulators consistently highlight the importance of reducing time lost to workplace injuries. Return-to-work outcomes are not just a measure of scheme success – they are critical for the wellbeing of workers and the productivity of employers.

But achieving better outcomes requires smooth coordination, timely interventions, and proactive support. When communication is inconsistent or delayed, recovery stalls. Workers may disengage, employers may become frustrated, and disputes can arise.

Closing the Gap

The challenges are clear: complex claims, high expectations, strict compliance, inefficient processes, and the ever-present pressure to improve outcomes. Together, they create a gap between what Workers’ Compensation organisations want to achieve and what current systems and processes allow them to deliver.

In the second part of this series, we’ll explore how improved communication and stronger interactions across all stakeholders can help close this gap and lead to better outcomes for workers, employers, and regulators alike.

To learn more about this topic, or speak to experts in the field, register to come see us at PIEF tradeshow on October 25th.

Turning Missed Payments into Better Customer Outcomes with Journey Orchestration

By Gordon Tang, Product Marketing Manager at Smart Communications 

In the first part of this series, we explored why missed payments are rarely just billing events. While every missed payment may follow a similar operational path, the customer circumstances that created it can vary significantly. Behind every missed payment is a personal customer story. This creates a challenge for insurers trying to balance compliance requirements, operational consistency, customer experience, and commercial outcomes. 

The natural question is what happens next. 

If insurers already have payment recovery processes, communication platforms, business rules, and governance frameworks in place, what is missing? 

For many organisations, the answer is not another process. It is a better way of connecting operational events to customer needs. 

The Need for a Customer Resolution Mindset 

Many collections processes and programs are built around a single objective: recovering the outstanding premium. 

While that objective remains important, it is increasingly insufficient on its own. 

A customer who has forgotten to update payment details requires a different journey to a customer experiencing financial hardship. A customer who wants to maintain cover requires different support to a customer who is reconsidering the value of the policy altogether. 

The challenge is that the operational trigger remains the same in each case. A payment has been missed. Without additional context, insurers can only assume what should happen next. Those assumptions often lead to generic experiences that may fulfill compliance requirements but fail to address the customer’s actual needs. 

A more effective approach is to focus on customer resolution rather than simply payment collection. Resolution starts by understanding the customer’s situation and helping them move toward the most appropriate outcome. 

Why Understanding Intent Matters 

At the heart of every missed payment is a question that most systems cannot answer on their own. 

Why did it happen? 

Understanding customer intent allows insurers to move beyond the event itself and focus on the circumstances behind it. Rather than treating every customer the same, organisations can begin identifying the drivers behind different behaviours and determining the most effective response. 

This creates opportunities to deliver better outcomes across multiple areas of the business. 

Customers who simply need to update payment details can be guided toward a fast and convenient resolution. Customers experiencing hardship can be directed toward specialist support pathways. Customers questioning the value of their cover can receive information that helps them make informed decisions about their policy. 

The objective is not merely to classify customers. It is to understand enough about their circumstances to make the next interaction more relevant and more effective. 

Orchestrating the Right Next Action 

Insight alone is not enough. Once customer intent is understood, organisations need the ability to act on it. 

But rather than pushing every customer through the same sequence of interactions, insurers need the flexibility to guide customers toward the next best action based on their circumstances, business rules, and regulatory obligations. 

That action may involve updating a payment method, establishing payment arrangements, reviewing policy coverage, engaging a specialist support team, or accessing hardship assistance. The right answer depends on the customer, not simply the event that triggered the interaction. 

Importantly, this does not require organisations to abandon consistency. It requires them to become more intelligent about how consistent processes are applied and experienced, particularly at scale 

Personalisation and Compliance Can Coexist 

One of the most common misconceptions in insurance is that personalisation and compliance sit at opposite ends of the spectrum.   

In reality, they solve different problems. 

Compliance frameworks are designed to ensure fairness, governance, and accountability. Personalisation is designed to improve relevance and customer engagement. There is no inherent conflict between the two. 

Insurers do not need unique compliance rules for every customer. They need the ability to create experiences that feel relevant while still operating within a consistent and auditable framework. 

Customers should experience interactions that acknowledge their circumstances. Regulators should see evidence of control, consistency, and appropriate governance. The most mature organisations are increasingly focused on achieving both outcomes simultaneously. 

The Role of SmartPATH™ 

This is where SmartPATH comes into the picture. 

Rather than acting as another payment recovery solution, SmartPATH serves as the connective layer between customer needs, operational processes, and regulatory requirements. 

It helps insurers understand customer intent, identify potential vulnerability or hardship indicators, orchestrate appropriate next actions, and create more relevant customer journeys without compromising governance controls. 

The result is that organisations can maintain the consistency, compliance, and auditability required in a regulated industry while delivering experiences that feel much more personalised and customer-centric. 

The process remains governed. 

The experience becomes more relevant. 

That distinction is what allows insurers to move beyond a purely transactional approach and focus on creating better customer outcomes. 

From Payment Recovery to Customer Resolution 

The future of this challenge is not about recovering payments. It is about helping customers navigate the circumstances that led to the missed payment in the first place. 

Organisations that focus exclusively on collection activities may recover premiums, but they can miss opportunities to strengthen relationships, reduce churn, identify vulnerability, and improve customer trust. 

The insurers that lead in this space will take a broader view. They will recognise that missed payments are often signals of a deeper customer need and will invest in the capabilities required to understand and respond to those signals effectively. 

Learn How SmartPATH Enables Transformation for Insurers 

To see how missed payments can create opportunities and better customer outcomes, plus stronger policy retention, and compliant customer engagement, request a demo today.

Why Insurers Need to Rethink the Way They View Payment Recovery

By Eileen Potter, VP of Insurance Marketing at Smart Communications

Meeting customer expectations while ensuring regulatory requirements are met can sometimes feel like competing priorities. Customers want easy–to–understand, relevant experiences that reflect their circumstances. Regulators want consistency, fairness, and evidence that customers are being treated appropriately. Insurers need to protect revenue, retain customers, and operate efficiently. Success increasingly depends on doing all of these things simultaneously. 

When customers miss a premium payment, these competing priorities are thrown into stark contrast. 

At first glance, the situation appears relatively straightforward. A customer has missed a payment, the insurer needs to recover the premium, and a defined process is triggered to guide the issue toward resolution. Credit cards and direct debit transactions are retried, generic reminder emails sent, and perhaps a broker needs to be advised.  

However, anyone involved in collections knows that missed payments are rarely just billing events. They often sit at the intersection of customer retention, vulnerability management, compliance obligations, service experience, and commercial performance. What makes the challenge particularly difficult is that insurers and customers often view the same event through very different lenses. 

The Difference Between What Happened and Why It Happened 

For an insurer, a missed payment is an operational event. A premium was not received, a payment method failed, or a collection attempt was unsuccessful. The systems know what happened and can initiate the appropriate workflows in response. 

What they do not automatically know is why it happened 

That distinction is more important than many organisations realise. While every missed payment may trigger the same operational process, the circumstances behind the event are often completely different. 

One customer may have received a replacement credit card and forgotten to update their payment details, or they may be overdrawn on their limit. Another may have changed banks. Someone else may be dealing with short-term financial pressure, an unexpected life event, or competing household priorities. Some customers may even be questioning whether they still need the cover, or the level of cover, they have in place. 

The operational process looks identical, but the customer context varies significantly. 

This is where many insurers encounter problems. By focusing exclusively on the payment event itself, organisations can miss valuable information about what is actually happening in the customer’s world. 

Why Traditional Recovery Approaches Are Becoming Less Effective 

Historically, payment recovery was often viewed as a transactional process. The objective was to contact the customer, obtain payment, and maintain policy continuity wherever possible. Efficiency, consistency, and process adherence were the primary measures of success. 

Today, the expectations are much broader. 

Insurers are expected to demonstrate that customers are treated fairly, that hardship and vulnerability are identified where appropriate, and that interactions support positive customer outcomes. The compliance environment is more robust than ever. At the same time, businesses remain accountable for reducing lapses, protecting revenue, minimising complaints, and improving retention. 

This means success is no longer determined solely by whether a payment is recovered. Increasingly, it is determined by how the customer was treated throughout the process and whether the experience contributed to a sustainable outcome for both parties. 

When every missed payment receives the same treatment, organisations risk overlooking the factors that matter most. Generic communications can feel impersonal. Customers experiencing hardship may not receive the support they need. Customers who simply need to update payment details may be forced through unnecessary steps. In both cases, the experience becomes more difficult than it needs to be. 

Customers Don’t Think in Processes 

One of the biggest challenges for insurers is that customers don’t think about payment recovery the way insurers do. 

Customers do not wake up worrying about collections workflows, cancellation notices, governance controls, or operational policies. They think about managing their finances, protecting their families, dealing with unexpected life events, and resolving issues as quickly as possible. 

When a payment is missed, customers are typically focused on the circumstances that caused it rather than the process that follows. 

A customer who is experiencing financial hardship is looking for support. A customer who forgot to update their card details is looking for convenience. A customer reviewing their insurance needs is looking for reassurance that their cover remains valuable. 

While these customers may enter the same operational process, they are not looking for the same outcome. 

This creates an important challenge for insurers. The goal should not be to build a different process for every customer. That would be difficult to govern, expensive to maintain, and almost impossible to scale. Instead, organisations need to find ways to make a consistent process feel more relevant to the individual moving through it. 

The Missing Layer Between Operations and Experience 

Many organisations assume that a well-designed process automatically creates a good customer experience. In reality, processes and experiences serve different purposes. 

Processes are designed to ensure consistency, compliance, and operational efficiency. Customer experiences are shaped by whether people feel understood, supported, and guided toward the right outcome. 

Connecting those two worlds requires more than workflow automation. It requires the ability to interpret the meaning behind an event and respond appropriately. 

A missed payment should be viewed as a signal rather than simply an unpaid invoice. It signals that something has changed. The challenge is understanding what that change represents and how the organisation should respond. 

The insurers that succeed in the years ahead will be those that become better at interpreting those signals. They will focus not only on recovering premiums but also on understanding customer intent, removing unnecessary friction, and helping customers reach an appropriate resolution. 

Looking Beyond the Payment 

Missed payments will always require operational processes, governance controls, and compliance oversight. Those fundamentals are not going away. 

What is changing is the expectation that insurers understand the person behind the payment event. Customers increasingly expect interactions that reflect their circumstances, while regulators increasingly expect evidence that those circumstances have been appropriately considered. 

Viewing missed payments as customer signals rather than isolated billing events is an important first step. The next challenge is translating that insight into action. In the second article in this series, we’ll examine how insurers can bridge the gap between process and experience by understanding customer intent and guiding customers toward the right resolution, while maintaining compliance and operational consistency. 

Next Steps for Leading Insurance Organisations 

Curious how leading APAC insurers are starting to treat missed payments as moments of insight rather than just billing events? Part two will unpack the tools and approach. In the meantime, get in touch with our team to talk through what this could look like for your organisation. 

The Hidden Cost of Manual Appeals & Grievances (A&G) for Health Plans

Appeals & grievances (A&G) are among the most complex and compliance–sensitive processes for health plans. Every appeal requires document collection, case routing, clinical review, member communications, compliance tracking, and audit-ready record keeping. 

When these activities rely on manual processes and disconnected systems, costs rise, resolution tiles slow, and regulatory risk increases.  

According to our partner, Cognizant, manual A&G handling can cost up to $45 per case due to document gathering, multiple handoffs, medical review, and compliance tracking. Appeals may arrive through mail, fax, portals, call centers, and regulators—often incomplete, misclassified, or duplicated, delaying the compliance clock. 

 In the US, the American Hospital Association ( AHA) found that Medicare Advantage denials rose 55.7% year over year, driving higher appeal volumes and regulatory scrutiny. Health plans must also meet strict response deadlines – sometimes as short as 24 hours – while maintaining complete audit trails across intake, communications, decisions and document retention. 

Bottom line: The process is expensive to operate, difficult to scale, and increasingly risk to manage manually.  

Smart Communications Creates Value Across the A&G Lifecycle 

Smart Communications’ platform aligns naturally to A&G needs because it covers the entire process: intake → orchestration → communications → archiving. Payers typically integrate the Smart solutions with a case management system (e.g., Pega, Salesforce, etc.). 

SmartIQ™ for Intelligent A&G Intake 

What it solves 

  • Manual keying of appeals and grievances
  • Incomplete or invalid submissions
  • Delayed compliance clock start

Value drivers 

  • Dynamic digital forms for members, providers, and regulators
  • Automated classification (appeal vs. grievance, standard vs. expedited)
  • Required documentation validation on submission 

ROI impact 

  • Reduced intake handling time
  • Fewer invalid or abandoned cases
  • Faster clock start = lower compliance risk 

SmartPATH™ for Case Orchestration & Digital Delivery 

What it solves 

  • Manual routing and handoffs
  • Missed deadlines
  • No end‑to‑end case visibility 

Value drivers 

  • Automated routing to clinical, legal, or vendor review
  • SLA tracking against CMS timelines
  • Omnichannel digital delivery (portal, secure email, print fallback) 

ROI impact 

  • Shorter cycle times
  • Lower labor cost per case
  • Reduced need for third‑party tools 

SmartCOMM™ for Compliant A&G Communications 

What it solves 

  • Inconsistent templates
  • High IT dependency for updates
  • Regulatory language risk 

Value drivers 

  • Business‑managed templates for appeal acknowledgments, decisions, and regulator letters
  • Multilingual, multi‑brand compliance
  • Single‑source template governance 

ROI impact 

  • Reduced IT and compliance review costs
  • Faster regulatory updates
  • Lower rework and call volume due to clearer notices 

SmartHUB™ for A&G Archiving & Audit Readiness 

What it solves 

  • Disparate document systems
  • Expensive audits and legal discovery
  • Poor regulator response readiness 

Value drivers 

  • Cloud native archive of all case documents and correspondence
  • Fast retrieval by member, case, or regulator
  • Immutable audit trail 

ROI impact 

  • Reduced audit prep labor
  • Lower legal and compliance exposure
  • Faster regulator inquiries response 

How to Calculate the ROI of Modernizing Appeals and Grievances Processes 

We can calculate the return on investment of investing in a Smart appeals and grievances solution. We’ll need some input from you to personalize the calculations, but we’ll start with an example that you can customize. Here’s what you’ll need: 

Input Category 

Examples 

Annual A&G volume 

Total appeals + grievances 

Avg. cost per case 

Labor + overhead 

% paper based intake 

Member & provider 

Avg. cycle time 

Days to resolution 

Compliance penalties 

Historical or estimated 

Call volume driven by A&G 

Per case 

The following calculations show how these inputs can translate into potential savings across operational costs, labor productivity, compliance, call volume, and audit and legal costs.  

Output Metrics of the A&G ROI Calculator 

After considering your inputs and running through the calculations, above, we will be able to determine: 

  • Annual Gross Savings
  • Net Benefit (Savings – Platform Cost)
  • Payback Period (months)
  • 3‑Year NPV
  • Cost per A&G case (before vs. after) 

Why A&G Is an Ideal ROI Use Case for Smart Communications 

Unlike claims where savings are incremental, A&G ROI compounds across: 

  • Cost
  • Compliance
  • CX
  • Regulator trust
  • Star ratings and retention 

Appeals & Grievances are no longer a back office necessity; they are a financial, regulatory, and member experience lever. SmartIQ, SmartCOMM, SmartPATH, and SmartHUB together enable payers to lower cost, reduce risk, and deliver defensible, compliant outcomes at scale. 

With documented A&G automation savings of 30–40% per case and rising volumes, even mid‑size plans can justify investment quickly. 

What Could Your Organization Save? 

See how much your health plan could save by automating appeals and grievances. Calculate your potential ROI today.  

Frequently Asked Questions 

Q: Why should health plans modernize appeals and grievances?

Health plans should modernize appeals and grievances to reduce manual work, improve turnaround times, strengthen compliance, and deliver a better member experience. Automation can also reduce costs by streamlining workflows and reducing avoidable errors. 

Q: What should health plans look for in a modern appeals and grievances solution? 

Look for a solution that automates workflows, supports regulatory compliance, integrates with existing systems, and provides visibility through tracking and reporting. It should also enable personalized, omnichannel communications throughout the appeals and grievances process. 

Q: How can Smart Communications help me improve my appeals and grievances workflow? 

Smart Communications helps health plans automate and streamline appeals and grievances workflows, from intake and routing through decisioning and member communications. Its solutions can reduce manual effort, improve consistency and compliance, and create a more connected member experience. 

Q: What is Smart Communications’ appeals and grievances ROI calculator? 

Smart Communications’ appeals and grievances ROI calculator helps health plans estimate potential savings from automating their A&G processes. It calculates potential value across operational costs, labor productivity, compliance risk, call deflection, and audit and legal costs. 

Citizen Trust Is Built in the Moments Between Services

Why government agencies need to focus on the quality, consistency and clarity of every citizen interaction.

By Ken Macdonald, Public Sector Lead, Smart Communications 

Government agencies have made significant progress in digitising access to services. Citizens can now apply, renew, update, request and respond through more channels than ever before. 

But access alone is no longer enough. 

At a recent executive roundtable hosted by Smart Communications and Synergy, public sector leaders came together to discuss a pressing question: how can agencies build citizen trust through more connected, consistent and inclusive service experiences? 

The discussion centred on a shared reality. Citizens are no longer judging government services only by whether they are available online. They are judging them by how easy, clear, responsive and human those experiences feel in practice. 

That theme is strongly reflected in our 2026 Benchmark Report: Citizen Experience in APAC, which found that government interactions are increasingly judged by ease and effectiveness, not simply digital availability. The report, based on a survey of more than 1,400 individuals across APAC, highlights a clear pattern: access has improved, but friction persists across channels, forms, self-service and overall experience.  

Citizen Expectations Have Permanently Changed 

One of the clearest themes from the discussion was the pace at which citizen expectations are evolving. 

As Scott Lawry, Chief Digital Officer at the Department of Natural Resources and Mines, Manufacturing and Regional and Rural Development, observed during the discussion, many citizens have never really experienced an analogue world. Seamless, intuitive, always-on experiences are not a novelty for them. They are the baseline. 

This shift is not limited to younger citizens. Across the community, people are increasingly bringing expectations from banking, retail, insurance, logistics and digital platforms into their interactions with government. 

That does not mean government should simply copy the private sector. The public sector operates with different obligations, different levels of complexity and a responsibility to serve everyone, not only the easiest-to-reach audiences. 

Kate Hillman, Synergy Queensland Office Managing Partner, noted during the discussion, private sector organisations can often choose which customers to prioritise. Government cannot. That makes inclusion, accessibility and channel choice essential parts of service design. 

The Benchmark Report reinforces this point. Citizens across APAC show a clear preference for digital engagement, with 65% preferring digital or online channels, but they also continue to rely on phone, in-person and mail options depending on the situation. The report’s conclusion is important: citizens want digital-first, but not digital-only. They expect to move between channels based on context, without having to repeat information or restart steps.  

For government agencies, the challenge is not just offering more channels. It is making those channels work together. 

Trust is Shaped By Everyday Communications 

A recurring point throughout the roundtable was that trust is not built only through major policy outcomes or large-scale transformation programs. It is built, or lost, in everyday service moments. 

A notification that arrives at the right time. 

A form that is easy to complete. 

A decision letter that is clear and accessible. 

A status update that removes uncertainty. 

A consistent message across SMS, email, portal, phone and in-person service channels. 

These moments may seem operational, but they are deeply connected to trust. 

The Benchmark Report found that 88% of citizens say communications are important to their overall experience with government agencies. It also found that 72% trust government agencies more when communications are consistent across channels, while only 53% say agencies always or almost always use their preferred channel.  

That gap matters because communication is often the most visible part of the service experience. Citizens may not see the workflow, the approval process, the data handoff or the system dependency behind the scenes. But they do experience the message, the form, the reminder, the response and the follow-up. 

When those interactions are clear and connected, confidence increases. When they are inconsistent, inaccessible or incomplete, trust can quickly erode. 

Consistency is One of Government’s Toughest Communication Challenges  

One of the biggest challenges discussed at the roundtable was how agencies can maintain consistency across complex operating environments. 

Government services often span multiple departments, systems, channels, policy settings and frontline teams. In some environments, not all staff have access to the same tools or communication channels. In health, for example, many frontline workers may not have regular access to email or a desk-based communication environment. 

That creates a difficult question: how do agencies ensure the same message reaches the right people, in the right way, at the right time, without losing consistency? 

This challenge applies to citizen communication as well. 

Participants discussed the importance of providing flexibility of channel while maintaining consistency of message. Different communities have different needs, preferences and access points. Some citizens may expect mobile-first updates. Others may rely on paper, phone or in-person support. Some may need accessible communications. Others may be navigating services during moments of stress, uncertainty or disruption. 

The goal is not to force everyone into the same experience. It is to ensure that no matter which channel a person uses, the message remains clear, accurate, accessible and aligned. 

The Benchmark Report highlights why this matters. Communications play a central role in shaping citizen experience, and consistency across channels is closely linked to trust. Where communications are aligned and predictable, confidence increases. Where they are fragmented, the experience becomes less reliable.  

Modernisation Must be Practical, Not Overwhelming 

Another strong theme was the reality of modernisation in the current fiscal environment. 

Many agencies are being asked to do more with what they have. They are expected to improve services, reduce friction, increase accessibility, respond faster, support digital transformation and maintain compliance, often without the appetite or budget for large-scale system replacement. 

This makes prioritisation critical. 

The Benchmark Report points to several areas where friction remains visible to citizens. Forms continue to be a major pain point, with 53% of citizens saying they always or sometimes re-enter the same information across multiple forms. It also found that 46% say forms are too long or repetitive, 33% cite unclear instructions and 31% report no tracking or confirmation.  

These are not abstract digital transformation issues. They are practical service experience problems. They affect completion, confidence, inbound enquiries and trust. 

The report notes that digitisation alone is no longer sufficient. Citizens may be completing forms digitally, but many still encounter manual, fragmented and static processes behind the scenes.  

For agencies, this creates a clear opportunity. Rather than trying to replace everything at once, leaders can identify high-friction journeys and focus on improvements that reduce effort, provide clarity and create visible value for citizens and staff. 

Small wins matter. A clearer status update. A more guided form. A consistent message across channels. A better handoff between systems. A more accessible communication delivered at the same time as standard correspondence. 

These improvements may not look like major transformation programs, but they can have a meaningful impact on trust. 

Trust As a Defence Against Misinformation 

The roundtable also explored trust in an age of misinformation and disinformation. 

Government communication now operates in a far more complex information environment. Citizens are exposed to competing sources of information, AI-generated content, social commentary and, in some cases, deliberate attempts to undermine confidence in public institutions. 

This makes clarity and consistency even more important. 

If citizens cannot easily identify the right source of truth, understand what action they need to take, or trust that a message is accurate and secure, agencies risk losing confidence at exactly the moments when clarity matters most. 

The Benchmark Report found that the biggest drivers of trust are operational and experience-based. Accuracy of communications, data security, ease of contacting government, response time, consistency across channels and proactive updates all influence trust.  

It also found that transparency around AI is becoming increasingly important. Only 43% trust government entities to use AI responsibly in ways that benefit them, while 84% say it is important that organisations disclose when AI is used in interactions.  

As AI-led search and AI-assisted service models become more common, government agencies will need to think carefully about how citizens find, verify and trust information. The question is no longer only “how do we communicate?” It is also “how do citizens know this communication is accurate, secure and genuinely from the agency?” 

The Citizen’s Experience Should Come Before Designing the Journey 

A powerful point raised in the discussion was the importance of understanding who the customer really is. 

One example shared during the session referenced a university shifting its view of the customer from academics to students, which changed how it understood and invested in the student journey. 

The same principle applies in government. 

Agencies must continue asking whether the citizen voice is present when decisions are made. Are services designed around internal structures or citizen outcomes? Are communications written for the agency or for the person trying to complete a task? Are communities being engaged in ways that reflect their preferences, constraints and access needs? 

This is especially important because public sector communication is rarely one-size-fits-all. Citizens differ by age, digital access, language, location, accessibility needs, life stage and level of confidence navigating government services. 

Understanding those preferences is not a soft measure. It is central to effective service delivery. 

The Benchmark Report states that trust is increasingly shaped by how clearly, quickly and consistently outcomes are communicated. As government services become more digital, timely updates, transparent processes and responsive engagement are essential drivers of citizen trust and confidence.  

The Path Forward: Connected, Inclusive, and Human Centred 

The roundtable made one thing clear: improving citizen trust does not depend on one major transformation program. It depends on the quality of the interactions citizens experience every day. 

For government leaders, the opportunity is to focus on a few practical priorities: 

  • Identify the journeys where citizens experience the most confusion, delay or duplication.
  • Improve consistency across channels so citizens receive the same clear message, regardless of how they engage.
  • Treat accessibility and inclusion as service quality issues, not only compliance requirements.
  • Use communications to reduce uncertainty, not simply to deliver information.
  • Build transparency into data use, AI and digital interactions. Look for small wins that build trust, release capacity and create momentum for broader change. 

Citizen trust is not built in a single moment. It is built through every interaction, every communication and every service experience. 

As expectations continue to rise, the agencies that make the greatest progress will be those that connect the dots between communication, workflow, data and human experience. Not by adding more complexity, but by making government easier to understand, easier to navigate and easier to trust. 

Explore the 2026 Benchmark Report: Citizen Experience in APAC 

See where citizens are experiencing friction, what drives trust, and how agencies can prioritise practical improvements across communications, digital journeys and service experiences. Read the report today.

 

How Customer Communication Orchestration Improves Engagement

By Gordon Tang, Product Marketing Manager at Smart Communications

As organizations look beyond individual touchpoints and toward more connected experiences, customer communications orchestration has become increasingly important in helping businesses deliver the right information, through the right channels, at the right time. 

As we’ve explored previously (here), delivering on those expectations is only getting harder as the goalposts continue to shift. For regulated industries especially, where the focus often leans heavily toward compliance, it’s easy to lose sight of what actually strengthens a customer relationship. 

Organizations can earn and maintain customer trust by communicating clearly, consistently, and through the channels customers prefer. But when communications are treated primarily as a compliance exercise, something important is lost. The opportunity to truly engage disappears, and with it, the visibility, responsiveness, and control customers now expect.  

Our continued focus on improving customer interactions has led to our inclusion in the Omdia Universe: Customer Engagement Platforms, 2026. As the Product Marketer for SmartPATH™, I—and the wider team—are incredibly excited to see our capabilities recognized. For the sake of this article, here’s what I’m covering: 

  • A high-level look at customer communications orchestration and how it works, plus the importance of it for highly regulated industries
  • How SmartPATH supports customer communication orchestration 

What Is Customer Communication Orchestration? 

Customer communication orchestration is the coordination and optimization of customer interactions across touchpoints and channels—to deliver experiences that are timely, relevant, and consistent throughout this customer journey. 

Customer engagement isn’t a new concept. Analyst firms have been studying it for years. Since 2018, Omdia has surveyed customers and vendors to better understand how organizations approach engagement, defining what they call the Customer Engagement Platform (CEP) market. In their 2026 report, Omdia’s Mila D’Antonio suggests that many organizations have reached a kind of inflection point: 

“They [technology buyers] know customer engagement is evolving faster than their tech stack, and they want to know which engagement platforms can actually take them into the future rather than bolting new features onto old foundations.” 

This captures a reality many organizations are grappling with today. In 2026, Smart Communications made its debut in this research, within a market valued at approximately $30 billion. Our inclusion reflects our ability to support engagement in regulated industries, where complexity is the norm: 

“From the beginning, Smart Communications focused on scenarios where customer engagement is not just about convenience or speed but about precision, compliance, security, and auditability. That heritage gives it credibility in complex, high–stakes interactions where traditional CCaaS platforms or lightweight CRM-driven engagement tools often fall short.” 

The report explores key areas of focus for CEP technology, including: 

  • Platform convergence: moving away from the multi-vendor, multi-interface approaches to technology that create disjointed databases, in favor of a simplified and unified platform (ideally from a single vendor)
  • Data unification: a solution that helps to create a clear and unified customer profile that updates in real time, rather than disconnected applications that create a segmented and outdated customer view
  • Technology modernization: a future-thinking technology solution that can adapt and evolve with the changing requirements of an enterprise (that are equally driven by the changing requirements of their customers), over legacy solutions that are no longer fit for purpose without supplementary integration into additional applications 

Each of these points in the same direction: organizations need a more connected, coordinated approach to engaging customers. 

Why Is Customer Communication Orchestration Important? 

It’s a deceptively simple question—and something of a trick. Customers don’t fit neatly into personas, their needs shift depending on the moment, the context, and the channel. They expect the right information at the right time—and they expect their experience to continue seamlessly, even when they switch channels, hit friction, or need follow-up. 

And those expectations are not standing still. Our 2026 CX benchmark research found that email remains the most widely preferred communication channel, while more than one-third prefer SMS, web portal/mobile app, or encrypted messaging depending on the context. At the same time, more than 80% of Gen Z and Millennials prefer digital self-service over speaking to customer service teams—yet many organizations still rely heavily on traditional outbound print communications. 

Omdia summarizes the challenge well: “As customer expectations continue to rise and digital engagement becomes more complex, enterprises are rethinking the foundations of how they operate. The challenge is no longer simply delivering better experiences via individual channels. It is coordinating every interaction, decision, and workflow across the entire organization in real time.”  That’s easier said than done. 

Organizations are being asked to deliver clearer, faster communication across a growing number of channels—while managing increasing regulatory pressure and tighter turnaround times. At the same time, they must maintain consistency across journeys that span multiple teams and systems. It’s a difficult balancing act. 

At times, it can feel like trying to juggle batons while riding a unicycle across a trapeze line—one that just happens to be moving toward a pit of flames. And to make things more interesting, the technology stack supporting you is often held together by years of custom integrations. 

How Does Customer Communication Orchestration Work? 

Simply put, customer communications orchestration works by continuously syncing real-time data across systems to deliver the right message, on the preferred channel at the exact moment the customers needs it. 

As a leader in CCM technology, Smart Communications understands how critical communications are to engagement. But in today’s environment, designing, creating, and sending messages isn’t enough. Sometimes, you need to ensure your message actually reaches the customer. This is where orchestration comes in. 

Orchestration is about making sure the right message reaches the right customer at the right time, even when things don’t go as planned. Maybe an email address has a typo. Maybe an SMS is blocked. Maybe a customer simply forgets to act and needs a reminder. Orchestration connects communication delivery to the broader customer journey. It introduces adaptability, persistence, and intelligence, while still supporting compliance and delivering on business outcomes. 

Benefits of Customer Communication Orchestration  

Sophisticated customer communication orchestration solutions will help organizations to: 

  • Quickly deploy and lower maintenance costs
  • Scale globally without sacrificing performance
  • Handle data and compliance support securely
  • Increase agility with the use of AI and automation 

 

How Does SmartPATH™ Support Customer Communications Orchestration? 

In 2025, SmartPATH joined Smart Communications’ suite of solutions following our acquisition of Pendula. This marked an important step forward, as it introduced orchestration capabilities that transform traditional communications into true engagement, especially for regulated industries. It’s also a key factor behind our inclusion in the Omdia CEP report. 

SmartPATH extends the value of our CCM proposition by enabling native omnichannel delivery and orchestrating communications across the entire customer journey. It connects what were previously separate capabilities, bringing them together into a more unified engagement solution. As part of a broader Customer Engagement Platform, SmartPATH aligns with what Omdia describes as a unified approach, bringing inbound and outbound communications together and expanding traditional CCM into full engagement capability. 

The result is a shift from disconnected interactions to cohesive, customer-driven experiences—delivering better outcomes and higher satisfaction. 

CEP as a Natural Extension for Smart Communications 

Our inclusion in Omdia’s 2026 report reinforces something we’ve long believed: Smart Communications belongs in this space. This isn’t about entering a new market. It’s about recognizing the natural evolution of what we’ve been building. 

Through SmartCOMM™ and SmartIQ™, we’ve built a strong reputation for enabling complex communications in regulated industries. SmartPATH builds on that foundation, extending those capabilities into the broader domain of customer engagement. It elevates communications from individual touchpoints into connected journeys, aligned with how customers experience organizations today. In many ways, this is about giving language to what we already do — and where we’re heading next. 

A Note from the Author 

This is my first blog for Smart Communications so, I’m finishing big with Gandhi. What if I told you that in 1890 he (allegedly) said:

“A customer is the most important visitor on our premises. He is not dependent on us. We are dependent on him. He is not an interruption of our work. He is the purpose of it. He is not an outsider of our business. He is part of it. We are not doing him a favour by serving him. He is doing us a favour by giving us the opportunity to do so.” 

The translation: everything you do should ultimately be for the customer’s benefit. And that still holds true today because when you give customers what they want, they reward you with trust and loyalty. 

For more, download a complimentary copy of Omdia Universe: Customer Engagement Platforms, 2026.  

Frequently Asked Questions 

Q: How is communication orchestration different from CCM? 

The two are related but distinctly different. Whereas CCM focuses on creating, managing, and delivering communications—communication orchestration focuses on the coordination of these communications, across an entire communication journey. If the former fulfils a single event, then the latter turns those events into something more for the customer—ensuring that the right message is sent at the right time, through the right channel. 

Q: Why do regulated industries need orchestration? 

When customer communications are often business–critical, compliance-sensitive, and tied directly to customer interactions—it makes sense to be able to send, manage, and ensure successful delivery of these autonomously and seamlessly. These communications are not just messages, they are the outputs of regulated business processes—orchestration through technology like SmartPATH unburdens manual resources from execution, drives down costs to serve, and ensures that organizations remain compliant as they scale their customer growth ambitions. 

Q: Why was Gandhi weighing in on customer service? 

Note that I said allegedly—the very powerful quote about the importance of the customer has been attributed to a speech by Gandhi in South Africa in 1890. There are no written records of why he may have said this, or even that he actually did—but equally if this was a misattribution, there is no record of when this happened either.  Still, how many articles have you read that reference Gandhi! And regardless of who said it, the quote is still a great one that perfectly encapsulates what the customer means for a business.

Smart Spotlight: Michelle Kothe on Life at Smart

At Smart Communications, our people are what make us truly Smart. Through our Smart Spotlight series, we highlight team members whose talent, dedication, and collaboration drive innovation and shape our culture. 

This month, we’re excited to feature Michelle Kothe, Engineering Manager for SmartIQ. Michelle shares her journey from running her own business to leading a talented technical team, what’s kept her at Smart for nearly a decade, and how teamwork and curiosity fuel her success. 

1. What is your role at Smart and how long have you been with the company? 

I am the Engineering Manager for SmartIQ, I manage a group of technical teams in the engineering department who all work on the SmartIQ product. These teams between them do everything from adding new features to the SmartIQ product, evaluating and implementing customer enhancement up to working with Support to fix customer bugs, keeping our testing platforms working and managing and ensure regular product releases on schedule or hotfix patches if needed. I see my role as helping each team by getting any roadblocks out of their way and ensuring they have all the support and resources needed to do their jobs. Ultimately the quality of the software at each release is my responsibility. 

I have been with the company since 2016 when it was Intelledox, prior to being acquired by Smart Communications. I worked as a Software Engineer in that capacity. 

2. What did you do for work prior to joining Smart, and why did you make the switch? 

I ran an online accommodation booking business with my husband, sister, and brother-in-law for about eight years. After selling that business, I did consulting work on short-term projects before joining Smart.  

I made the switch because consulting was unpredictable with frustrating contract extensions and unknowns. I prefer the stability and flexibility of full-time work at Smart, where I love the product and company culture. 

3. What’s kept you at Smart? 

I love problem solving, the variety of challenges, the team environment, and the company’s great vibe and flexibility. I’m grateful that Smart supports work-from-home and treats employees with respect and understanding. Dealing with people who are reasonable and want you to enjoy your job is part of what creates that excellent culture we enjoy here at Smart. 

4. What skills are needed to be successful in your role/on your team? 

To be successful in this role, you really need a balance of technical ability and teamwork. Everyone in the engineering teams has a core set of IT and problem-solving skills, but what really makes them all functional is how they respect each other’s strengths and know when to rely on one another.  

Problem-solving in IT takes a particular mindset — you have to be analytical and curious, but also collaborative. It’s about understanding that no one person has all the answers, and that the best solutions often come from combining different perspectives. 

I focus on ensuring everyone has a clear understanding of their tasks and roles and that they know they can rely on me to get them what they need and when they need it or find the right person. I also have to keep a close eye on overall quality and how new features, fixes and improvements interact with the existing code to ensure that customers can rely on and trust our product. 

5. What’s your favorite aspect of your job? 

My favorite aspect is the thrill of solving complex problems, like tracking down the cause of an issue after weeks of investigation and implementing fixes that improve the product. 

6. What are you doing when you’re not working? 

I do a lot of triathlon training including swimming, running, and cycling. I also do volunteer work occasionally, travel with my husband, and enjoy spending time with my family. I have a daughter and a son, and my niece has lived with us for many years. My son is finishing his engineering degree, and my daughter and niece both work in government roles related to IT and policy support. 

If you’re interested in joining our dynamic team, we invite you to explore our current opportunities on our Careers page. 

 

 

Healthcare Member Enrollment and Onboarding: Challenges, Solutions, and Best Practices

Enrollment and onboarding are among the most critical moments in the member lifecycle. Yet for many health plans, these processes remain fragmented, manual, and difficult to scale. 

That creates a dangerous combination: operational inefficiency, rising cost, and a poor first impression for members. 

And the data backs it up. A recent McKinsey study found that most Medicare Advantage members are dissatisfied with their onboarding experience. And recent J.D. Power studies show that new members of commercial health plans are significantly less satisfied than established members, with onboarding experience being a major driver of dissatisfaction. That’s not just an experience issue; it’s a business problem. 

Why is Healthcare Member Onboarding So Difficult? 

If you step inside most payer environments, enrollment and onboarding aren’t owned by a single system—or even a single team. 

Instead, they span: 

  • Exchange platforms and broker portals
  • Core administration systems (Facets, QNXT, TriZetto EAM)
  • CRM applications
  • Billing systems
  • Communication platforms and print vendors 

Each system performs a function. But none owns the experience. 

The result? 

  • Data is captured in one system, validated in another, and communicated somewhere else
  • Manual intervention fills the gaps
  • Errors introduced early propagate downstream 

This fragmentation is systemic across payer operations. Even broader payer workflows suffer from siloed systems and disconnected engagement tools, which continue to degrade member experience and operational visibility. 

The Real Cost of Healthcare Onboarding Inefficiency 

The impact of these issues isn’t always immediately visible—but it shows up everywhere: 

1. Revenue Leakage and Delays 

Nearly 46% of healthcare organizations report revenue impact from slow or inefficient enrollment workflows. 

Delays in onboarding don’t just slow operations, they delay payment and activation. 

2. Rising Administrative Costs 

McKinsey estimates that automation and digital transformation can deliver $150M–$300M in administrative savings per $10B in revenue for payers. That 1.5-3% savings would flow down to the bottom line; a margin boost even smaller payers would like to see. 

That number is driven largely by: 

  • Manual enrollment processing
  • Data rework
  • Print-heavy communications
  • Call center demand 

3. Call Center Overload 

Enrollment and onboarding confusion directly translates into demand. 

Healthcare call centers: 

And much of that volume is preventable. 

Many of those calls are caused by confusion about: 

  • ID cards
  • Coverage dates
  • Provider networks
  • Benefits 

Clarifying these would drive down avoidable calls, repeat contacts, and cost-to-serve. 

4. Data Errors and Rework 

Enrollment depends heavily on 834 transactions. But poor data quality, missing fields, and transaction errors require constant intervention and reconciliation—which can delay onboarding and even prevent timely delivery of ID cards and welcome materials. 

Why are the First 90 Days so Important for Member Engagement? 

Operational inefficiency is only part of the story. The bigger issue is experience. The first 90 days set the tone for the entire member relationship, influencing trust, engagement, satisfaction, and long-term retention. 

The first 90 days determine: 

  • Whether members understand their benefits
  • Whether they engage with care
  • Whether they stay 

And today, those early experiences are often broken. 

Members are frequently: 

  • Overwhelmed with generic communications
  • Confused about what their plan covers
  • Unsure how to use benefits 

Less than 25% of members actively engage with their health plan during the first 90 days. 

That’s a missed opportunity and a revenue risk. Because when members don’t understand their plan, they churn. In fact, onboarding-driven confidence is one of the strongest predictors of retention and satisfaction in healthcare plans. 

Why Can’t Core Payer Systems Deliver Modern Onboarding Experiences? 

Traditional enrollment and onboarding systems can’t solve today’s challenges because they weren’t designed to deliver connected, omnichannel member experiences. 

Most payers have already invested heavily in core systems. 

These platforms are essential for: 

  • Eligibility
  • Enrollment transactions
  • Billing
  • Claims 

But they were never designed to deliver: 

  • Personalized communications
  • Omnichannel engagement
  • Dynamic onboarding journeys
  • Real-time data capture experiences 

Those gaps are where the problem lives. Payers aren’t lacking systems. They lack connection between them. 

A New Approach: Connecting the Enrollment Experience 

Leading payers are shifting their mindset. For them, enrollment and onboarding are no longer treated as back-office processes. They’re being reimagined as connected, end-to-end experiences. 

That transformation focuses on four key capabilities: 

1. Data Capture: Capture complete and accurate data at the point of entry 

2. Communications: Deliver clear, personalized, and compliant information 

3. Journey Orchestration: Guide members across channels and time 

4. Content Governance: Ensure consistency, compliance, and scalability 

Individually, these exist. Together, they transform onboarding. 

What Should Health Plans Looks for in an Enrollment and Onboarding Solution? 

Modernizing enrollment and onboarding isn’t just about replacing technology. It’s about choosing a solution that can simplify operations while creating better member experiences across the entire journey. 

As you evaluate options, look for capabilities that help connect processes, communications, and experiences rather than adding another point solution to your technology stack. 

A modern enrollment and onboarding solution should include: 

  • Guided digital forms that simplify data collection, reduce errors, and help members complete enrollment with confidence.
  • Omnichannel communications that deliver consistent, personalized experiences across email, SMS, web, print, and other preferred channels.
  • Workflow automation that reduces manual effort, streamlines approvals, and keeps enrollment moving without unnecessary delays.
  • Event-driven journeys that trigger the right communication at the right time based on member actions and lifecycle events.
  • Integrations with core administrative systems and existing technologies to eliminate duplicate data entry and improve operational efficiency.
  • Content governance that enables teams to manage communications centrally while maintaining consistency across products, brands, and channels.
  • Audit trails and version control that support compliance, simplify reporting, and provide confidence that the right content reaches the right members.
  • Scalability that allows organizations to start with a single use case and expand across products, lines of business, and member journeys over time. 

The right solution shouldn’t just improve one part of the process. It should create a connected foundation that helps health plans deliver better member experiences, operate more efficiently, and adapt as expectations and business needs evolve. 

How Smart Communications Helps Payers Close the Gap 

At Smart Communications, we’ve seen firsthand how connecting these capabilities transforms both operations and experience. 

We help payers modernize enrollment and onboarding through four integrated capabilities: 

Intelligent Data Capture 

  • Guided, dynamic enrollment experiences
  • Real-time validation to prevent errors
  • Reduced rework and faster processing 

Personalized Communications at Scale 

  • Automated welcome kits, ID cards, and onboarding materials
  • Omnichannel delivery (print, email, SMS, digital)
  • Clear, plain-language communication 

Member Journey Orchestration 

  • Event-driven onboarding journeys
  • Personalized, milestone-based engagement
  • Continuous interaction across the first 90 days 

Content & Compliance Control 

  • Centralized content management
  • Version control and audit readiness
  • Faster updates across markets and products 

Smart Communications customers leveraging these strategies have seen dramatic reductions in call volume—up to 80% in some cases. 

Extending (Not Replacing) Core Systems 

A key advantage of this approach is that it works with existing infrastructure. Core systems from HealthEdge, TriZetto, and others remain the system of record. 

Smart Communications becomes the experience layer that: 

  • Connects data across systems
  • Eliminates manual handoffs
  • Enables real-time, event-driven communication
  • Accelerates change without core system releases 

It’s integration—not replacement—that unlocks value. 

What Modern Enrollment and Onboarding Deliver 

When enrollment and onboarding are transformed, the results are measurable: 

  • 40–70% reduction in manual effort
  • 20–50% faster onboarding cycles
  • 30–60% reduction in compliance defects
  • Significant reductions in call volume 
  • 10–25 point improvements in member satisfaction scores 

And perhaps most importantly: 

  • Lower cost-to-serve
  • Faster revenue realization
  • Higher retention rates 

From Cost Center to Competitive Advantage 

Enrollment and onboarding will always be complex. Regulatory requirements will continue to evolve. Volume will continue to grow. But complexity doesn’t have to create friction. 

The organizations leading in this space aren’t simplifying the ecosystem, they’re connecting it. They understand that: 

  • Data drives accuracy
  • Communication drives understanding
  • Experience drives retention 

And when those elements come together, onboarding becomes more than a process. It becomes a competitive advantage. 

Final Thought 

The first 90 days of the member relationship are too important to leave to fragmented systems and manual processes. 

Enrollment and onboarding are more than operational steps. In fact, they’re an opportunity to create defining moments. 

If you’re thinking about how to modernize them, now’s the time. Explore how leading payers are transforming onboarding. Connect with Smart Communications to see what’s possible. 

Frequently Asked Questions  

Q: Why do health plans need to improve member engagement after onboarding? 
Health plans need to improve member engagement after onboarding because early interactions build trust, encourage healthier behaviors, and drive long-term satisfaction and retention. 

Q: What are the biggest challenges in payer enrollment and onboarding? 
Fragmented systems, manual processes, poor data quality, and inconsistent communications create inefficiencies, errors, and poor member experiences. 

Q: Why is onboarding so important in healthcare? 
Onboarding shapes first impressions, influences CAHPS and Star Ratings, and directly impacts retention and engagement. 

Q: How does onboarding affect call center volume? 
Member confusion during onboarding, especially around benefits and coverage—drives avoidable call volume and repeat contact. 

Q: What results can health plans expect from modernization? 
Health plans can achieve significant gains, including reduced cost, faster onboarding, improved compliance, and higher satisfaction. 

Q: Can enrollment modernization improve star ratings? 
Yes, enrollment modernization can support higher Star Ratings by improving member engagement, increasing preventive care participation, reducing confusion, and creating more timely, personalized communications throughout the member journey. 

Q: How does Smart Communications help? 
Smart Communications connects data capture, communications, orchestration, and content into a unified experience layer without replacing core systems. 

Call Me, Maybe? Why Clear Customer Communications Matter More Than Ever

By Dani Duffy, Content Marketing Manager at Smart Communications 

If you’re the parent of a young adult like I am, you’ve probably witnessed the same scenario: they’ll do just about anything to avoid calling customer service. 

They’ll search FAQs, open a chat, or send a message before picking up the phone. That behavior is a signal, not a phase. 

Customers increasingly expect interactions to be digital-first, on-demand, and frictionless. In our latest benchmark research, 67% of customers said they’re likely to use digital self-service options, with that number climbing to 76% for Gen Z and 77% for Millennials. 

But choosing digital channels doesn’t mean lowering expectations. Customers expect those experiences to make sense immediately without additional effort on their part. Sound familiar? 

That’s where smarter storytelling comes in. Regardless of channel, whether it’s a printed letter, an email, or a text, customers don’t simply receive communications. They interpret them and decide (within seconds!) whether to engage or ignore.  

Remember: winning organizations tell clearer, more relevant stories designed for how modern customers behave. 

What the Data Says 

If customers are avoiding traditional support channels, communications suddenly carry more responsibility. They’re not just informing people; increasingly, they’re replacing conversations altogether. The data from our benchmark research makes that shift difficult to ignore. 

Perhaps the most telling finding is that customers often seek assistance not because they prefer human interaction, but because the communication itself didn’t get them where they needed to go in the first place. 43% say they contacted customer service instead of completing a process digitally because communications were unclear. 

That becomes even more important when viewed alongside generational preferences. Younger audiences aren’t just adopting digital channels; they actively prefer them. 

Likelihood of using digital self-service for tasks like asking questions, filing complaints, or making changes: 

  • 76% of Gen Z
  • 77% of Millennials 

And when processes still require manual effort, patience starts to disappear quickly. 

Percentage saying it’s important for organizations to offer digital data collection instead of printing, scanning, or mailing forms: 

  • 72% of Gen Z
  • 81% of Millennials 

Taken together, these findings suggest something larger than a channel preference shift. Communication volume isn’t shrinking. It’s simply moving into different places and taking on different forms. 

Customers still need guidance. They still need reassurance. They still have questions. 

They just increasingly expect the answers to come through intuitive digital experiences rather than phone calls. 

Why Does Storytelling Matter More Than Ever? 

Storytelling is grounded in how people process information. Research in psychology shows that when individuals engage with a narrative, they experience “narrative transportation,” becoming mentally immersed in the message. In that state, they’re more likely to understand, remember, and act on what they’re seeing. 

Just as importantly, stories reduce friction. Instead of forcing people to interpret dense or fragmented information, a well-structured narrative presents a clear sequence: what happened, what it means, and what to do next. Studies have found that this format lowers resistance and improves comprehension, making it easier for audiences to engage without second-guessing or seeking additional support. That matters even more in a digital-first world.  

Spotify offers a useful example on how to transform customer behavior into a personalized narrative through its “Wrapped” campaign. Instead of receiving statistics, users received a story about themselves. The result was more than 500 million engaged users within 24 hours, with sharing activity increasing 41% year over year. This doesn’t mean your organization needs a viral campaign. Rather, it’s a sign that customers engage deeply when communication with a brand feels personal, contextual, and built around them. 

As customers increasingly favor quick, self-service interactions over phone calls, communications need to do more of the heavy lifting. Your communications are more than touchpoints; they’re stand-ins for conversations. The organizations that get those conversations right are designing them as intuitive, story-driven experiences that guide customers to action. 

What Does Smarter Storytelling Look Like, Practically? 

Smarter storytelling means making every interaction easier to understand and easier to act on. That starts with context, using customer data to make communications feel relevant rather than generic. It requires structure, guiding people through a clear sequence of what happened, what it means, and what to do next.  

It also means adapting experiences to the channel itself, recognizing that a text message, email, mobile experience, and printed communication each create different expectations. Increasingly, the most effective communications also become interactive, allowing customers to move directly from understanding a situation to resolving it. 

Customer Service Isn’t Disappearing 

Customer service still matters, and it always will. 

But for a growing segment of customers, support is becoming something they prefer to avoid rather than rely on. Communications increasingly need to do the work conversations once did. 

The question isn’t whether you’re communicating. It’s whether your communications are doing the job of a conversation. Delivering communications this way requires more than document generation. Organizations need to personalize content, orchestrate delivery across channels, and guide customers toward the next best action.  

Ready to explore the latest digital experience insights? 

For more coverage on customer communications, data intake, channel preferences, and more, access the full Benchmark Research here. 

Frequently Asked Questions 

Q: Why do customers contact customer service instead of using self-service? 

When communications lack clarity or structure, customers are more likely to disengage or seek support through alternative channels. In many cases, unclear messaging becomes the trigger for customer service contact, increasing operational load and frustration. This is why communication design directly impacts both customer satisfaction and service demand. 

Q: How can organizations operationalize smarter storytelling at scale? 

Organizations can operationalize smarter storytelling by combining customer data, workflow automation, and channel orchestration. This enables communications to be dynamically personalized, consistently structured, and automatically delivered through the most appropriate channel. Scalable storytelling also requires governance to ensure tone, clarity, and compliance remain consistent across journeys. 

Q: When should customers still be routed to human customer service? 

Human customer service remains essential when issues are complex, emotionally sensitive, or require judgment that automated systems cannot provide. While smarter communications can resolve many routine interactions, they should be designed to reduce — not eliminate — the need for human support. The most effective models combine self-service resolution with clear escalation paths to human assistance when needed. 

Q: How does Smart Communications help regulated industries increase communication clarity and storytelling relevance? 

SmartCOMM™ and SmartPATH™ help turn individual communications into connected customer journeys.