Help On Demand Capability Statement

Big Wave Systems, LLC — Capability Statement (Insurance Exchanges)

Scope

Big Wave Systems provides software and operational support capabilities used by insurance exchanges and other health insurance programs to connect consumers to qualified, licensed, and program-approved experts. The platform supports configurable intake, rules-based matching/routing, distributed expert networks, and reporting for oversight and performance management.

Core Capability: Help On Demand (HOD)

Help On Demand (HOD) is a rules-driven connection and referral workflow that works alongside existing exchange operations (e.g., CRM, IVR, contact center tools). Based on program-defined criteria, consumer requests can be routed to an appropriate expert and tracked through defined statuses for accountability and reporting.

Insurance Exchange Use Cases Supported

Consumer assistance for new enrollment, plan selection questions, and application support workflows
Routing to licensed agents/brokers and other approved assister roles (program-defined)
Support for distributed networks (remote experts participating without call-center seats, where allowed by program policy)
Peak-volume and seasonal surge operations (e.g., open enrollment) with configurable routing and prioritization
After-hours intake and next-available follow-up workflows (program-defined)

Key Functional Capabilities

1) Intake and Data Capture (Program-Defined)

Capture a defined set of intake fields that the program chooses (e.g., location, language, call reason, eligibility flags, preferred contact method)
Support for inbound flows that can originate from voice/IVR and other channels, depending on integration approach
Structured handoff of intake data into the matching and tracking workflow for consistent reporting

2) Rules-Based Matching and Routing

Configurable business rules to match consumers with qualified experts based on program criteria (e.g., geography, language, licensure/role, skills, availability)
Configurable routing behaviors (e.g., sequential routing, fallback routing, reassignment rules)
Controls to reduce unassigned or unworked requests through automated reassignment/escalation logic (program-defined)

3) Distributed Expert Network Operations

Profile management for participating experts (credentials/role attributes, service area, language, skills)
Availability signaling and participation controls (program-defined)
Support for programs that rely on independent, geographically dispersed experts

4) Tracking, Oversight, and Reporting

Track request status and progression through program-defined lead states and workflow steps
Operational reporting on follow-up speed and outcomes (based on available data and integration scope)
Auditable records suitable for oversight and performance review

5) Integration Approach

Designed to work alongside existing CRM and call technology rather than requiring replacement of the program’s systems
Secure data exchange patterns to pass structured intake into HOD and return status/outcome signals to external systems (as implemented)
Optional integrations with portals, CRM/ticketing systems, and reporting platforms through APIs (as implemented)

Security, Privacy, and Hosting

Designed for environments that handle personally identifiable information (PII), with administrative and technical safeguards implemented according to program requirements
Typical control areas include least-privilege access, MFA support, audit logging, and configurable retention (program-defined)
Deployment within AWS is supported; telephony implementations may use Amazon Connect where appropriate

Optional Add-on: Real-time Call Handling (Warm Transfer)

This optional add-on keeps the consumer on the line while the platform identifies an available, qualified expert and completes a warm transfer. If no experts accept within a program-defined window, the workflow can transition to a standard follow-up model using the same collected intake context.

Real-time Call Handling Workflow

Intake via IVR and keep the caller on the line
Apply program matching rules (e.g., geography, licensure/role, language, skills, availability)
Place simultaneous outbound calls to multiple matching experts (configurable)
Select the first expert to accept; release the others to reduce duplicate outreach
Bridge the accepting expert into the live call for a warm transfer; if no acceptance, route to follow-up workflow

Operational Characteristics

Supports a one-to-one connection model (one consumer to one accountable expert)
Configurable hours of operation, acceptance windows, fallback behaviors, and eligibility filters
Designed for distributed networks; experts can participate using a standard phone (no call-center seat required)
Scalable for peak periods; enables auditable outcomes and performance metrics

Integration and Deployment Options for the Add-on

Inbound voice: IVR and call flows configured to collect program-defined intake fields
Data handoff: Structured intake data transferred into the HOD workflow for matching, tracking, and reporting
External systems: Optional integration with portals, ticketing/CRM systems, and reporting platforms via API
Operational modes: Can be used after-hours for intake with next-available follow-up; can co-exist with call-center operations