Member services

Empathetic peak and off-peak support to improve enrollment

Redefine the traditional member experience

Our goal is simple – helping modern health plans deliver high value care.

For over 20 years, we have delivered complex customer experience management (CXM) programs for some of the largest health plans, helping them build enduring member relationships. Our wide-ranging solutions leverage a powerful blend of human intelligence, digital support pathways, AI, automation, and analytics to elevate the end-to-end member journey.

The outcome-focused solutions drive down costs, improve accuracy, and increase efficiency for your health plan while unlocking better health outcomes, experience, and affordability for your members.

Dedicated centralized licensing department

Oversees licenses, renewals, and advocate appointments
Houses over 5000 advocate files and 32,000 licenses
Acts as 50-state purchasing platform for new licenses and renewals
Syncs with National Producers Database to update advocate license and appointment data
In house pre-licensing school accelerates path to licensing
Partnership with licensed staffing experts offers access to an expanded pool of advocates

#ResultsMatter

Above client set goal for appointments scheduled

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Financial accuracy for managed Medicare claims

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Improvement in CSAT with Conversational AI

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Point increase in overall NPS driven by analytics

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Our services

Enrollment

Tap into comprehensive enrollment services, including Plan selection, plan change, Annual Notice of Change (ANOC) communication, and member education

Member services

Drive efficient benefits, eligibility, pre-authorization, and claims processes with the help of our CPT code expertise and integrated RPA and Intelligent Document Processing capabilities

Explanation of benefits

Proactively educate your member population about their health benefits and ensure the right coverage for each member

Pharmacy & prescription drug plan benefits

Leverage our prescription plan and pharmacy refill support to help your members effectively manage their prescriptions

Member outreach

Drive better health outcomes through welcome calls, transition needs assessments, health risk assessments, disease management, medication adherence, and health, wellness preventative care

Balance bill resolution, grievances & appeals

Take a resolution-centered approach to quickly and accurately resolve billing issues, grievances and appeals, improving member satisfaction

CAHPS & STAR

Positively impact CAHPS & STAR ratings by aligning health plan SLAs with CMS guidelines and harnessing a data and best practices-driven outreach

Make social media your CX superpower

Reimagine Customer Experience on Social Media

How we do it

Building a strong foundation

Our recruitment and training strategy ensures that our advocates deliver outstanding member experiences.

From using targeted profiles and AI-driven algorithms to identify the right candidates to enabling best practices-based training in industry knowledge, language, soft skills, culture, and customer personas.

Taking the member experience beyond sales and support

Our unique Health Advocacy Model places individual members at the center of everything we do – listening with empathy and building genuine connections to fully understand member needs and respond with caring assistance that makes lives better.

Driving frictionless journeys

On the one hand, our comprehensive complaint management program (CIP) fueled by speech analytics acts as an early warning system – helping us proactively identify issues and mitigate risks. On the other, our AI-enabled knowledge management system provides deep insights, driving continuous process improvements and easing the member journey