I’ve spent years watching companies promise transformation while delivering incremental tweaks. So when Claudia Nicholls, Chief Customer Officer at Simplyhealth, told me they’d reduced complaints from 600 to 40 while handling 2.5 million customers, I knew this wasn’t another cautious pilot project story.
This sounded like a masterclass in fixing what’s broken before attempting to grow.
At Salesforce’s Agentforce World Tour 2025, Nicholls and Dan Eddie, Simplyhealth’s Director of Customer Service, shared how a 153-year-old health insurance provider escaped what Eddie calls “a bit of a pickle.”
Indeed, prior to Salesforce’s involvement, Simplyhealth struggled with legacy systems that didn’t talk to each other, claims that took up to 10 days to process, collapsed phone lines, and complaint resolution times that stretched beyond 16 days.
The company’s moment of truth (the claims process) was failing spectacularly.
Members submitted claims after visiting the physiotherapist only to wait five to seven days, sometimes 10, for approval and payment. Customer satisfaction plummeted, complaints piled up, and contact volumes surged as frustrated customers called repeatedly for updates.
Eddie detailed the severity of the situation Simplyhealth found itself in.
“If you’ve got an outstanding complaint, and if you as a customer have submitted a claim, you don’t know where you’re at, that’s going to drive contact and cost into the business, so it’s this self-fulfilling disaster that we were in.”
The company’s purpose (providing access to healthcare for all) couldn’t scale on a foundation of poor experience. Nicholls, a Marketer by trade with 10 years at Procter & Gamble, understood a fundamental truth: spending on brand or performance marketing is wasteful if your experience doesn’t match your promise.
So how exactly did Simplyhealth manage to turn this around?
The Five-Year Vision
Rather than chase quick wins, Simplyhealth built a five-year transformation roadmap connecting technology directly to purpose. The strategy focused on three pillars:
- Channel mix evolution
- The balance between human and AI agents
- Operational efficiency that could support growth without proportional cost increases
Eddie explained how his team created a transparent year-by-year vision showing exactly what the future would look like:
“Anyone of my team could say, ‘Dan, okay, so in year three, you’re bringing WhatsApp in, and you’ve got a channel shift, and AI is doing 30%, what does that mean for me?’ and we can describe what that looks like.”
The honesty extended to difficult conversations. When team members assessed their “will and skill” for working in a digital-first environment, some chose to leave. Eddie acknowledges this, explaining that there were “certain jobs that [got] replaced. It’s just that, as long as you’ve got the ability and the will to learn, then it doesn’t jeopardize your job.”
Over three years, Simplyhealth removed 40% of roles while increasing compensation for remaining staff by 40%. The team became multi-skilled across products, channels, and complex value-adding work.
Starting Small, Scaling Smart
The transformation began with email, chosen deliberately because it allowed careful curation of the knowledge base within Salesforce.
The existing knowledge repository was cluttered with product information and irrelevant content. Eddie’s team manually cleaned it out, then filled it strategically with 500 previously sent emails reflecting Simplyhealth’s tone and brand, covering three frequently asked questions.
Four people received permission to use Agentforce. The first query (“How do I change dentist?”) came through, and AI responded in 1.5 seconds with an empathetic, helpful answer. A human checked it, pressed send, and what previously took 10.5 minutes now took 1.5 minutes.
Seven emails we sent in the first week, generatively with a human in the loop. 14 emails the week after, 21 the week after that, Eddie said.
The team returned to their AI governance forum (co-chaired by Eddie and the CTO, including fraud, compliance, and risk stakeholders) to review customer feedback and validate results before scaling.
Today, Simplyhealth sends 2,000 AI-assisted emails weekly across multiple frequently asked questions.
The company also now operates AI shifts during overnight hours, weekends, and holidays when human staff prefer not to work and customers appreciate 24/7 availability.
The Channel Shift Nobody Predicted
Four years ago, voice calls represented 60% of Simplyhealth’s channel mix. Today, it’s 12%.
This dramatic shift occurred despite the company’s customer base skewing older, a demographic often assumed to prefer phone contact.
“Everything is on your phone. So why not healthcare? Why not insurance?” Nicholls asked. WhatsApp launches in Q1 2026, and Eddie envisions customers staying in their preferred channel for the entire journey, from asking questions to submitting claims to completing renewal documents.
The company is testing in-app messaging and exploring voice-through-channel capabilities, where customers could speak to their phone – asking questions such as ‘How much have I got left in my physio pot, and when’s my renewal date?’ – and receive verbal or text responses without opening an app or making a call.
Governance Without Gridlock
Simplyhealth operates as a regulated business, which means its AI governance framework must satisfy board-level risk appetite while enabling innovation. The AI forum assesses every new AI initiative through a risk framework, evaluating whether existing tools already solve the problem and whether ethical standards are met.
“We’re a regulated business, so that allows us to operate within the agreed risk appetite that we have agreed with our board,” Nicholls explained.
The best team members have freedom to move faster than planned timelines if data supports it, without waiting for formal approval dates.
Weekly reporting provides traffic light indicators across key metrics. When conversational AI resolution rates dropped over two weeks, the team immediately investigated and discovered a technical glitch.
In addition, the company recently deployed Edge Tier’s AI quality assurance platform, which analyzes 100% of chats, voice interactions, and emails, flagging issues in real time.
Eddie outlined a scenario of how these tools work in practice:
“Five customers have rung about not being able to claim this morning. Well, hang on a minute, okay tech, can you have a look please? Yes, there’s a problem.” The result was the issue being resolved in less than one hour.
The Results That Fund Growth
The transformation delivered across three measurement lenses: business value, customer experience, and employee engagement.
Claims processing dropped from five to seven days to 0.83 days, claim satisfaction reached 99%, overall customer satisfaction hit 87%, contact volume fell by 160,000 interactions across all channels, and complaints dropped from 600 to 40.
Simplyhealth itself rose from 45th to 31st place in the KPMG Global CX Report, climbing 15 positions in one year.
The employee lens proved equally important. Simplyhealth measures change management through “speed to happiness,” which tracks how staff receive changes, scored out of 10.
Recent scores of seven and eight prompt investigation into the missing points. The company uses Peakon platform for employee engagement measurement, and staff report they’ve never been happier working at Simplyhealth.
These results created the business case for brand investment and Eddie is clear about the connection: “The pipeline is now 800% of last year’s level, with conversion rates climbing quarterly.”
The Human-in-the-Way Problem
Outside of discussing Simplyhealth’s performance, Nicholls also spoke more generally about AI in CX. In particular, she challenged the industry’s common phrase, “human in the loop,” which Salesforce and others use as reassurance when discussing AI.
She prefers “human in the way.”
“Once you’ve got technology like that in place, the AI checks there, and it can’t go wrong. And if something does go wrong, because your system can always fall over, you’ll know straight away,” she said. The transformation changes quality assurance from fact-checking to insight generation.
Two examples illustrate the shift. First, QA analysis revealed customer confusion about payment timing after claim approval. The team clarified the message in plain English, resulting in a 15% contact reduction the first week and 25% the second week, sustained over time.
One corporate customer called 10 times in one week. Instead of processing each call transactionally, the team called back to understand why. The customer didn’t know how to use the portal. A 30-minute training session eliminated all future calls from that customer.
“Can you draw the line from what QA do to a metric moving, to something changing? If you can’t, then it doesn’t work,” Eddie said. The team is nearly there.
The Philosophical Questions Ahead
As Simplyhealth enters year four of its five-year plan, Nicholls raises concerns that extend beyond technology implementation.
“We’re not hiring the junior roles anymore. So what does that mean for new people coming into the workforce, and what does that mean for your future leaders?” she asked.
“It’s not an AI tech Salesforce question, but it’s a philosophical question that I think we as a society need to find an answer to.”
The company continues testing voice search capabilities and exploring how voice-enabled AI might reshape not just the service experience but the entire business model. Eddie is working with Salesforce on voice-through-channel functionality, while Nicholls watches international markets where voice search adoption leads the UK.
The roadmap includes becoming what Nicholls calls “the Martin Lewis of health,” a trusted healthcare aggregator.
As partnerships expand in the digital space, navigation support will require 24/7/365 presence across channels. The goal is effortless experience: staying in WhatsApp to make a claim, complete renewal documents, and access encrypted information without switching platforms.
What This Means for You
Simplyhealth’s transformation offers a counter-narrative to the “move fast and break things” approach that dominates AI implementation discussions.
The company moved deliberately, transparently, and with rigorous governance while achieving results that many organizations would consider aggressive.
The transparency of the five-year vision allowed employees to make informed career decisions. The focus on fixing customer experience before investing in growth prevented wasted marketing spend. The insistence on data-driven validation at every stage built trust with regulators, board members, and customers.
Most importantly, Nicholls and Eddie rejected the deflection mindset that treats customer contact as a cost to minimize.
“They contact you for a reason. You need to understand what the reason is why they contact you, and if it’s because there’s friction, you need to remove the friction,” Nicholls said.
For CX leaders facing similar transformation challenges (legacy systems, regulatory constraints, aging customer bases, operational chaos), Simplyhealth’s journey demonstrates that the foundation matters more than the speed.
Fix what’s broken; build transparent roadmaps; measure across business, customer, and employee lenses; start small; validate constantly; and scale based on evidence.
The future Eddie and Nicholls envision isn’t about AI replacing humans; it’s about AI handling the easy lifting so humans can focus on complex, value-adding work that requires empathy, judgment, and the kind of healthcare navigation that changes lives.
In a country where 2.8 million people are on long-term sick leave and the economic deficit from health issues reaches beyond £150 billion, that purpose-driven approach to technology adoption matters far beyond one company’s bottom line.
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