Member services
Every member moment, from enrollment to renewal
Year-round member services for health plans, built to scale for AEP and OEP and stay strong in between.
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
Member services for every stage of the member journey
From the first enrollment call to the next renewal, ResultsCX supports your members year-round, scaling for AEP
and OEP and staying consistent in between.
Tap into comprehensive enrollment services, including Plan selection, plan change, Annual Notice of Change (ANOC) communication, and member education
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
Proactively educate your member population about their health benefits and ensure the right coverage for each member
Leverage our prescription plan and pharmacy refill support to help your members effectively manage their prescriptions
Drive better health outcomes through welcome calls, transition needs assessments, health risk assessments, disease management, medication adherence, and health, wellness preventative care
Take a resolution-centered approach to quickly and accurately resolve billing issues, grievances and appeals, improving member satisfaction
Positively impact CAHPS & STAR ratings by aligning health plan SLAs with CMS guidelines and harnessing a data and best practices-driven outreach
Enroll
Help members choose the right plan, and help them understand it.
Plan selection and plan changes
Annual Notice of Change (ANOC) communications
Member education during enrollment
Licensed advocates backed by a centralized licensing department
Onboard
Start every member relationship on the right foot.
Welcome calls
Needs and health risk assessments
Explanation of benefits from day one
Serve
Resolve questions accurately the first time.
Benefits, eligibility, prior authorization and claims
Pharmacy and prescription drug benefit support, including refills
CPT code expertise, RPA and intelligent document processing
Engage
Reach members before they need to reach you.
Proactive outreach for preventive care
Medication adherence support
Disease management outreach
Resolve
Turn a complaint into a reason to stay.
Balance billing support
Grievances and appeals, focused on fast, accurate resolution
Speech analytics that flags issues before they become complaints
Retain and rate
Protect the scores that protect your plan.
CAHPS and Stars improvement aligned with CMS guidelines
Data-driven outreach on the measures that matter
One Medicare Advantage client moved from 3 to 5 stars
#ResultsMatter
Member experience doesn’t end when enrollment does
Enrollment season brings the volume. Retention, Stars and loyalty are decided the rest of the year. Our licensed advocates scale up for AEP and OEP, then stay with your members through onboarding, benefit questions, care navigation and renewal.
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How we do it
People and AI, working as one operating model
What sets us apart
Over 30 years of CX experience across multiple industries
KPI-driven delivery for consistent and measurable quality and exceptional CX
Flexible and scalable engagement model to identify issues, analyze CX challenges, and collaborate together
End-to-end expertise across hiring, training, operational execution, and workforce management
