We have a voicemail setup with Exchange UM, with a SIP trunk connected from FreepBX to UM. When the users leaving voicemails, after hearing that has packet drops.
In Exchange server is seems 0 packet drop and MOS value also good, there is no network issue in between the servers. Codec to set to u law.
I do not have access to the Exchange side, but on the FreePBX side, I have this for the SIP trunk settings. This location does not have any quality issues like you are describing.