How A U.S. ROI Provider Resolved 80% Of Inbound Support Calls Instantly Without Building A Call Center

Client Overview

A U.S.-based release-of-information (ROI) services provider supporting law firms, insurance carriers, and third-party administrators.

The organization processes high volumes of requests for medical records, claim files, and supporting documentation. Requestors use a secure portal to submit requests, track progress, and receive completed records.

As usage scaled, inbound inquiries increased, driven by requestors seeking updates, clarifications, and issue resolution tied to their requests.

They did not operate a live inbound support function. All support was handled through asynchronous channels, which limited response speed and created operational pressure as volumes grew.

The Objective

The existing support model was not designed to handle real-time demand tied to active workflows.

• No mechanism for real-time request visibility during interaction: Requestors calling in had no way to access live status information. Every inquiry required internal lookup, verification, and manual response, creating a disconnect between system data and customer access
• High concentration of repetitive, low-complexity inquiries: A large portion of inbound demand was tied to predictable questions such as request status, missing documents, or expected timelines. These inquiries followed known patterns but still required manual handling
• Support workflow disconnected from request lifecycle systems: Inbound queries were not directly linked to backend systems, forcing teams to navigate multiple tools to gather information before responding
• Delays introduced across downstream legal and insurance processes: Requestors often operate within time-bound workflows. Lack of immediate access to updates slowed case progression and created follow-up cycles
• Linear scaling of effort with request volume: Every increase in request volume resulted in a proportional increase in support workload, with no system-level leverage to absorb demand
• Traditional call center model misaligned with inquiry type: Standing up an inbound team would introduce fixed staffing costs for a workload dominated by structured, repeatable interactions

The Solution

Orvera was deployed as a real-time inbound support layer, integrated directly with the organization’s request system.

• Integrated with live request data: Connected to the backend to fetch status, document progress, and billing details during the call
• Configured using existing workflows: SOPs, portal logic, and request states were used to define how the AI responds at each stage
• Mapped to common inquiry types: Status checks, record issues, billing queries, and access support, structured into conversational flows
• Handles full interaction within a single call: Verifies context, retrieves data, and delivers responses without transfers or callbacks
• Escalates with complete context when required: Exception cases are routed with summaries and request details for faster follow-up
• Deployed using existing inputs: No new processes required, built on current workflows and data

Results

The organization shifted from a delayed, ticket-driven model to real-time, interaction-level resolution.

• 80%+ of inbound inquiries resolved within the same interaction: Most callers receive complete answers during the call without requiring follow-up
• 15–20% of interactions escalated based on defined conditions: Only cases involving missing data, exceptions, or judgment are routed to human teams
• Routine inquiries removed from the support queue: Status checks and standard requests are resolved upstream, preventing ticket creation
• Immediate response layer established for all inbound demand: Every caller receives a response at the time of interaction without waiting cycles
• Standardized handling across all inquiries: Responses are consistent, aligned with system data, and independent of individual agents

Business Impact

The operational model shifted from reactive support to a structured, scalable system.

• Inbound support introduced without adding fixed operational cost: The organization enabled full inbound coverage without building or maintaining a support team
• Human effort redirected to high-value work: Teams now focus on exception handling, issue resolution, and coordination instead of repetitive inquiries
• Improved workflow continuity across the request lifecycle: Faster access to information reduced follow-ups and improved overall process flow for requestors
• Support capacity scaled independently of headcount: Increased demand no longer requires proportional increases in staffing or operational overhead
• Greater control and visibility into inbound interactions: Every interaction is captured, structured, and available for monitoring, improving oversight and consistency