A CASE STUDY
TRANSFORMING QA AND COMPLIANCE VISIBILITY WITH AI
Unified Healthcare Intelligence and Enterprise Data Integration
Industry
Healthcare
Domain
Data Engineering & Analytics
Client Overview
The Client is a leading Revenue Cycle Managed Services (RCMS) organization supporting over 200 healthcare clients across the United States. Its operations span high-volume contact centers managing patient billing, insurance collections, and care coordination.
Given the sensitive nature of healthcare interactions, call quality is not just an operational metric—it directly impacts patient experience, regulatory compliance, and financial performance.
BUSINESS CHALLENGE
The client’s contact center operations faced a fundamental limitation in quality assurance. Manual call auditing processes allowed for the review of only 3–5% of total call volumes, leaving the vast majority of interactions unmonitored.
Visibility Gap
Limited visibility into agent performance across large scale operations.
Regulatory Risk
Increased compliance risk, particularly around HIPAA adherence.
Human Bias
Inconsistent quality evaluation due to human subjectivity.
Cost Efficiency
High operational costs associated with scaling QA teams manually.
OBJECTIVE
The goal was to design and deploy a scalable, intelligent Quality Assurance platform that could:
Evaluate 100% of call interactions, not just sampled audits.
Ensure consistent and accurate compliance monitoring.
Provide near real-time feedback to improve agent performance.
Deploy within a secure on-premise infrastructure.
SOLUTION: PULSEAI360 AGENT ASSIST
Trellissoft deployed PulseAI360 Agent Assist, a Generative AI-powered platform designed to analyze 100% of customer interactions in real time. The solution was built to handle high-volume healthcare data with a focus on accuracy and speed.
CORE IMPLEMENTATION PILLARS
COMPLIANCE FLAGGING
Auto-identification of HIPAA
violations.
OBJECTIVE SCORING
Uniform criteria across all calls.
INSTANT FEEDBACK
Reduced lag from 72h to minutes.
DEPLOYMENT & INFRASTRUCTURE
To meet the stringent HIPAA requirements of healthcare RCMS, Trellissoft deployed the solution on premise using an NVIDIA H100 cluster. This ensured high-performance AI inference while maintaining full control over patient data.
Topic Intelligence
Classification of calls into IVR, predictive, and verified contacts for precise context.
AI Exception Handling
Flags “AI Rejected” interactions for immediate supervisor review to ensure accuracy.
PHASED ROLLOUT
The implementation followed a structured phase-in period, starting with a pilot group of business units. This allowed the client’s teams to gradually transition from manual QA processes to AI-assisted evaluation while maintaining operational continuity. Initial rollouts focused on high-risk compliance queues before scaling to cover all contact center agents.
RESULTS & IMPACT
The implementation of PulseAI360 delivered a step-change in both scale and effectiveness of quality assurance operations since its launch in September 2023.
12,000+
CALL EVALUATIONS / DAY
20+
HEALTHCARE CLIENTS ONBOARDED
|
Metrics Comparison
|
Legacy (Manual)
|
PulseAI360
|
|---|---|---|
|
QA Call Coverage
|
3% – 5% Sampling
|
100% Analyzed
|
|
Compliance Detection
|
Manually Detected
|
Auto-Flagged (Real-Time)
|
|
Feedback Lag
|
24 – 72 Hours
|
Near Real-Time
|
|
After-Call Work (ACW)
|
6 – 8 Minutes
|
2 – 3 Minutes
|
|
Agent Productivity
|
Static Improvement
|
+35% Gain
|
"PulseAI360 fundamentally changed how we measure and manage quality. We've moved from reactive sampling to proactive compliance oversight. Our agents now receive feedback instantly, and our QA coverage has expanded without increasing headcount."- DIRECTOR OF OPERATIONS, LEADING RCMS PROVIDER
KEY TAKEAWAYS
This unified data platform was strictly designed to consolidate fractured data streams, integrating distinct operational, partner, and financial systems through an automated ETL framework.
Full-Scale Coverage
AI enables 100% QA coverage, eliminating reliance on limited manual sampling.
Continuous Insights
Operational trends become visible in real-time, allowing for data-driven pivots.
Proactive Compliance
HIPAA compliance is proactively enforced, identifying risks as they occur.
Efficiency Gains
Significantly reduced dependency on large manual auditing teams.
CONCLUSION
By automating QA and compliance audits with PulseAI360 Agent Assist, the client achieved full interaction visibility, reduced compliance risk, and created a data-driven foundation for continuous improvement.
