Receptionist Brief

Your Receptionist is the AI that answers your main number. Members, new callers, people calling back after a campaign call, day or night: it picks up, greets them (by first name when it knows who's calling), and helps. If it can answer, it does. If it can't, it transfers the call, books a time, or logs an inquiry for your team, depending on how you've set up your escalations. It never makes up an answer, a time, or a name.

It's also the engine behind your follow-through. Every inquiry callback in your organization is made by the Receptionist, and it's the fallback for appointment callbacks too. So even if you never think about it, your campaigns lean on it.

You don't pick this one from the template picker. Every organization gets one Receptionist, set up for you, and you manage it from the Receptionist page in the sidebar. There's a Medicare version and an ACA version. This brief covers Medicare, with the ACA differences at the end. For setup (name, voice, routing, and escalations), see Configure Your Receptionist.

In the lines below, anything in brackets fills in for each caller: [First name], [AI name] (whatever you've named your Receptionist), [Agency], and [Carrier].

At a glance

Who answers

The Receptionist is made up of six AI employees. Which one picks up depends on whether the caller is already in your book and whether you're open. Your business hours flip the switch between daytime and after hours.

The other two make callbacks: one for appointments and one for inquiry answers. More on those below.

A caller counts as a member when their phone number matches someone in your book. Anyone else is a new caller, and careCycle creates a record for them so the call and any follow-up stay connected.

Not every call to your main number lands on the Receptionist. A member who's in the middle of a campaign that calls from your main number can land back in that campaign, and a member returning a recent callback goes straight to that callback. See How Inbound Calls Route for the full order.

What it can do

Your escalations decide what the Receptionist is allowed to do. Here's the full menu:

• Answer plan questions. For members, it can look up their Medicare Advantage plan's benefits (copays, deductibles, out-of-pocket max, drug coverage, and more) and answer just what they asked. It works from the plan code on their policy. See How Cora Answers Plan Questions.
• Transfer the call to one of your transfer destinations, during business hours.
• Book an appointment on one of your appointment configurations, so someone calls them back at a set time.
• Log an inquiry for your team to follow up on. See Handle Inquiries.

It only does what you've switched on. If transfers aren't set up, it never says it's transferring anyone. If booking isn't set up, it never offers or confirms a time. When it can't do the thing a caller wants, it takes the closest real action it has (usually logging an inquiry) and says so plainly: "I'll have someone follow up with you about that."

What callers hear

Members in your book (it uses their first name and carrier):

Hey [First name], thanks for calling [Agency]! I'm your always on member concierge assistant, here to help with questions about your [Carrier] plan. Just so you know, this call may be recorded for quality purposes. I can always get you the answer, or find someone who can. How can I help you today?

New callers:

Hey there, thanks for calling [Agency]! I'm your always on member concierge assistant, here to help with questions about the MA marketplace or your plan. Just so you know, this call may be recorded for quality purposes. I can always get you the answer, or find someone who can. How can I help you today?

On the Medicare side, the after-hours employees use these same greetings. The caller doesn't hear "we're closed" up front. The difference shows up in what the AI does next.

After the greeting, there's no script, because it doesn't know what people will ask. If they just say hi, it says "hey, how's it going?" and lets them get to it. If they open with the reason, it jumps right in.

A sample call

Here's how a typical daytime call with a member might go, with plan lookups, transfers, and inquiries all switched on. Real calls vary, since the AI follows the caller's lead.

AI: Hey Linda, thanks for calling Bayside Benefits! I'm your always on member concierge assistant, here to help with questions about your Humana plan. Just so you know, this call may be recorded for quality purposes. I can always get you the answer, or find someone who can. How can I help you today?

Member: Hi, yeah, I need to go to the dentist and I don't know what I pay for a cleaning.

AI: Sure, lemme check. Looks like cleanings are zero dollars, twice a year.

Member: Oh good. And my new card never showed up. My plan starts the first, right?

AI: Hmm, I don't wanna give you the wrong date on something this important. Lemme have someone confirm that and call you back.

Member: Okay, that's fine.

AI: Got it, I'll have someone follow up with you about your card and the start date. Anything else I can help you with?

Member: No, that's it.

AI: Okay, well you've got our number if anything else comes up. Hope you have a great rest of your day.

The AI answers the benefit question from the plan data, but won't confirm a start date it doesn't have on file, even when the member says it. That becomes an inquiry, and your team gets the follow-up.

How it handles things

Members during the day

This is the main one. It listens, figures out what they need, and helps or takes the next step:

• Benefit and coverage questions. It answers from the member's plan info. If the answer isn't there, it says so instead of guessing: "Hmm, I don't actually have that in front of me - want me to get you over to someone who can pull that up?"
• Facts it can't verify. If a caller says their plan is active, names a start date, or names a carrier that isn't in their plan info, it doesn't agree or build on it. It never tells a caller they "will be covered." It offers to have someone confirm: "I don't wanna give you the wrong date on something this important - lemme have someone confirm that and call you back."
• Medical questions. It points them to their doctor: "that's actually something you'd wanna talk to your doctor about."
• "Can I talk to a person?" With a transfer set up, it honors it right away: "yeah absolutely, let me get someone for you, one sec." Without one, it logs a follow-up: "yeah, I'll have someone reach out to you directly about that."
• The person they want isn't free. It logs a follow-up and never names a callback time it didn't actually book.
• "Take me off your list." It agrees right away: "you got it, I'll take care of that right now."
• "Are you a real person?" It's straight with them: "yeah, I'm an AI assistant - so what can I help you with?"

It keeps turns short (one thing at a time, one question at a time), never reads off a menu of options, and doesn't recite your phone number unless the caller wants it. They just called it, after all.

It never hangs up on someone. When the issue's handled, it checks in ("anything else I can help you with?"), and once they're done it closes with "okay, well you've got our number if anything else comes up. hope you have a great rest of your day."

New callers during the day

Same approach, for people who aren't in your book yet. They might be shopping for a Medicare Advantage plan, asking about enrollment, or calling about something else entirely. The AI doesn't have any plan info for them, so plan shopping and anything account-specific goes to your team through your escalations.

Heads up: if a new caller asks whether it's an AI, it says "yeah, I'm an AI assistant, but I've got your info pulled up right here," even though there's no info on file for a new caller. If that bugs you, tweak it in the Receptionist's employee chat.

After hours (members and new callers)

Same greeting and same habits, but these two know the office is closed and everyone's gone home. Most of the time, they log an inquiry so someone follows up once the team is back. If you've set up booking for after hours, they can book a time for the team to call back instead. When they can't do something, they tell the caller the team will follow up during regular business hours, never a made-up time.

After hours never offers a live transfer, since nobody's there to pick up. That's why each escalation has a separate After Hours setting.

Escalations

Escalations are where you decide, situation by situation, whether the Receptionist transfers, books, or logs an inquiry. Open them from the Receptionist page with Escalations. Each row is a scenario, with one setting for Business Hours and one for After Hours.

The two columns are what let one situation play out differently by time of day. A complaint can transfer to your team at 2 PM and become a logged inquiry at 2 AM. Plan shopping can book an appointment around the clock. Paperwork like a missing ID card can always be an inquiry.

Plan benefit questions aren't in the table. The AI answers those itself when the plan data has the answer, and falls back to your escalations when it doesn't. See Escalations for how the table works and Configure Your Receptionist for our recommended starting behaviors.

Callbacks

The last two employees handle follow-through, and this is where the Receptionist meets your campaigns.

Inquiry callbacks

When your team answers an inquiry and picks AI Callback, the Receptionist's inquiry callback employee makes the call. That's true for every inquiry in your organization, whether the Receptionist logged it or one of your campaigns did. It opens with:

Hi [First name], this is [AI name], your personal assistant from [Agency] again. I had a chance to run your question by the team, and I have your answer! Is now a good time?

It reminds them what they asked ("does that ring a bell?"), waits for them to remember, then gives your team's answer in plain words, a piece at a time if it's long. It doesn't take on new issues or improvise beyond the answer. If they've got more questions, it gives them your number. It signs off with "alright sounds good, I'll talk to you later then. take care. bye bye."

If the member misses the call and dials you back, the Receptionist recognizes them and picks up right where it left off:

Hi [First name], thank you for returning my call about your question for the team about your [Carrier] plan. This is [AI name], your virtual assistant from [Agency], and this call is being recorded for quality purposes. Is now a good time to hear the answer to your question?

How many times it tries, and when it texts, is up to your callback workflow. See Automate Inquiry Callbacks.

Appointment callbacks

When an appointment comes due and your appointment configuration has the AI make the call, the callback comes from the campaign that booked it, if that campaign has its own appointment callback employee. Otherwise (appointments the Receptionist booked, booking links, appointments your team created by hand, or a campaign without one), the Receptionist makes it:

Hi [First name], this is [AI name] from [Agency] calling for your scheduled appointment with our team. Is now still a good time?

It mentions the recorded line and, if now works, transfers them to your team: "ok great - let me get you over to them right now, just hang on one sec." It doesn't know what the appointment was about, so it doesn't guess or try to handle the issue itself. If now's bad, or someone else picks up and the member isn't around, it books another time and confirms it back so it feels locked in.

If the member calls back shortly after a missed appointment call, they hear:

Hi [First name], thanks for calling back, this is [AI name] from [Agency]. Is now still a good time to connect with a licensed advisor from our team?

See Automated Appointment Handling for reminders, no-shows, and who makes the call.

The cadence

There isn't one. The Receptionist never calls or texts anyone on a schedule. It answers when people call, and only dials out when an inquiry answer or an appointment callback is waiting.

ACA differences

The ACA Receptionist works the same way, with the same six employees. Here's what's different:

• Greetings. Members hear the same greeting as on the Medicare side. New callers hear the AI's name and "the ACA marketplace":

  Hey, thanks for calling [Agency]! I'm [AI name], your always on member concierge assistant, here to help with questions about the ACA marketplace or your plan. Also heads up, this line is recorded. I can always get you the answer, or find someone who can. So uh, how can I help you today?

• After hours says so. The ACA after-hours greetings add "it's currently after hours" (the Medicare ones don't).

• After hours leans on booking. The ACA after-hours employees book a time or log an inquiry, about equally. The Medicare ones mostly log inquiries.

• Plan questions. careCycle's plan benefit data covers Medicare Advantage plans, so on ACA calls expect benefit questions to go to your team through your escalations more often.

• Fewer written-in guardrails. The Medicare version spells out a few extra rules: never confirm a start date or "you're covered" it can't verify, and never claim a transfer or booking it can't do. The ACA version doesn't spell those out, and its "Can I talk to a person?" handling assumes a transfer is set up. If you run the ACA Receptionist, set up a transfer destination and test these situations in a simulation.

• Inquiry callbacks. When a member calls back about an answer, the ACA greeting doesn't mention their carrier.

Before you turn it on

• Choose how calls route. On the Receptionist page, pick AI Receptionist (the AI answers everything) or Direct Routing (your team rings first during business hours, and you can let the AI take after-hours calls). See Configure Your Receptionist.
• Set up your escalations. Point Transfer Call at a transfer destination and Book Appointment at an appointment configuration. Inquiries go to your Inbox and the Inquiries page, and the member's assigned agent gets notified.
• Get your book in, with plan codes. The more of your book careCycle has, the more callers get greeted by name, and accurate plan codes are what let the AI answer benefit questions. See Import Your Book of Business.
• Set your business hours. They decide daytime versus after-hours handling. See Business Hours and Holidays.
• Tune your callback workflow so inquiry answers reach people. See Automate Inquiry Callbacks.
• Test it. Run a simulation from the Receptionist page, then call your number and try a few questions. See Test Your Campaign.

Changing any of this

• Name, voice, and routing: the Receptionist page. See Configure Your Receptionist.
• What the AI says: chat with careCycle right on the Receptionist page. It works just like a campaign's Employees tab. See Edit Your AI with Employees.
• When it transfers, books, or logs an inquiry: Escalations on the Receptionist page. See Escalations.