logo
  • Industries
    • Healthcare
    • Telecom & Media
    • Retail
    • Technology
    • BFSI
    • Utilities
    Linkedin-new-icon Instagram-Icon Facebook-Icon Youtube-Icon
    Navigation-Bottom-Element

    Explore our Services

    Digital CX

    • Omnichannel CX
    • AI Operations & Bots
    • Social Experience Management
    • SupportPredict Self Learning Knowledgebase
    • SupportPredict Agent AI
    • SupportPredict Self Service & Bots

    Resolution-Centered CX

    • Customer Acquisition
    • Customer Care & Retention
    • Account Management
    • Complaints Management
    • Technical Support
    • Billing & Collections
    • Back Office Processing

    Analytics & Consulting

    • Data Visualization
    • Advanced Analytics
    • Speech Analytics
    • Business Process Optimization
    • Business Transformation
    • Customer Journey Mapping

    Healthcare

    • Member Acquisition
    • Member Services
    • Provider Services
    • Improving Health Outcomes
    • Healthcare Advocacy
    • CMS Stars
  • Outcomes

    Helping you drive competitive advantage

    Business Outcomes

    Revenue Acceleration

    • Sales Acceleration
    • LTV Maximization

    Cost Optimization

    • IntelliAgent
    • Workforce Management
    • Process Consulting & Excellence
    • AI & Data Ops
    • Performance Analytics
    • Agent Health & Wellness

    Enhanced Experience

    • Social Experience Management
    • Omnichannel & Intelligent Steering
    • NPS Predictor
    • Churn Reduction
    • FCR Booster
    Linkedin
  • Locations

    Discover our global network locations

    • United States
    • Honduras
    • Mexico
    • Work from home
    • EMEA
    • United Kingdom
    • Ireland
    • Bulgaria
    • South Africa
    • India
    • Philippines
    Linkedin Instagram-Icon Facebook-Icon Youtube-Icon
    Navigation-Bottom-Element
    Location1-img
    Location2-img
    Location3-img
    Location4-img
    Location5-img
    Location6-img
  • Insights

    Stay informed. Stay ahead.

    • All
    • Blogs
    • Case Studies
    • Healthcare Insights
    • Videos
    • Whitepapers
    • Glossary
    Latest whitepaper

    Reimagine Customer Experience Management on Social Media

    Download
    Navigation-Bottom-Element
    Linkedin Instagram-Icon Facebook-Icon Youtube-Icon

    Business outcomes
    that underpin your growth

    Watch video
  • Careers

    Experience a new world of work

    • Life @ ResultsCX
    • Our Values
    • Careers Blog

    Explore Opportunities

    • United States
    • Honduras
    • Mexico
    • Philippines
    • Bulgaria
    • India
    Navigation-Bottom-Element
    Linkedin Instagram-Icon Facebook-Icon Youtube-Icon
  • ESG

    For a better tomorrow

    • Environmental, Social, And Governance
    • Corporate Social Responsibility
    • R.E.A.L. Women
    Navigation-Bottom-Element
    Linkedin Instagram-Icon Facebook-Icon Youtube-Icon
  • Why ResultsCX

    The ResultsCX difference

    • About us
    • Our Story
    • Leadership
    • R.E.A.L. Women
    • Technology Partners
    • Awards
    • News
    • Technology & Security
    Navigation-Bottom-Element
    Linkedin Instagram-Icon Facebook-Icon Youtube-Icon

    Values that guide
    our teams everyday

    Watch video
  • UK / EMEA

    UK/EMEA

    • Banking
    • General Insurance
    • Consumer Credit
    • Fintech
    • Utilities
    • Private Equity
    • Start up/Scale up
    Navigation-Bottom-Element
    Linkedin Instagram-Icon Facebook-Icon Youtube-Icon

    Values that guide
    our teams everyday

    Watch video
talk to us

Provider and utilization management

Make it easy for providers to work with your health plan

Talk to an expert

Create a distinctive provider and member experience

With tightening margins and changing consumer expectations, modern health plans have the unique opportunity and incentive to reimagine the future of care delivery.

Our rich consumer engagement expertise and strong analytics capabilities enable in-depth visibility into individual care needs and utilization patterns across provider settings. This, in turn, allows us to proactively identify friction points early in the journey – mitigating downstream impact and making it easy for providers to work with you.

At the same time, our outcome-driven utilization management services integrate better with providers, accelerating pre-authorization, prioritizing necessary services, and improving access to care.

create-distinctive-provider

#ResultsMatter

Efficiency

Accuracy

Costs

Make social media your CX superpower

Get a complimentary social media analysis

Reimagine Customer Experience on Social Media

Download the Whitepaper

Our services

provider-service
Provider services

Simplify life for members – from membership verification to coverage status, preauthorization requirements, and claims/appeals status.

Relationship-building-experiences
Referral and authorization management

Streamline the end-to-end patient referral and authorization process. Gain actionable insights to improve care coordination.

education
Provider education

Drive self-service and best practice adoption, showcase opportunities to improve efficiencies, and reduce costs. Improve care management and directory management.

real-time
Real time claims adjudication, balance bill resolution, grievances, and appeals

Our trained advocates take a resolution-centered approach to fix claims, billing issues, grievances, and appeals quickly and accurately – boosting member and provider satisfaction.

web-support-new
Web support

Seamlessly support member queries across channels. Whether it’s phone, fax, or online portals, simplify interactions and create a frictionless journey.

real-time
Ancillary vendor support

Play an active role in your members health using a holistic approach. Enable appointment reminders and support for dental, vision, flex cards, transportation and so much more.

How we do it

Advanced analytics
We gather deep insights into member interactions and care needs across provider settings with our machine learning-powered speech analytics solution. The insights help us chart the best care options for your members in a timely manner.
AI-driven Knowledgebase
Our AI-driven knowledgebase SupportPredict helps identify areas of improvement across the member journey. The holistic approach elevates advocate performance as well as the provider and member journey – all while driving tangible business impact.
Innovation and value
Protecting PHI/PII is paramount to the trust we have built with each healthcare client. Built by our Certified Security experts, our secure CX platform leads the standards in security ratings by Bitsight, ranking #1 among over 40,000 providers every month since 2021.

What sets us apart

AI operations & bots
Driving business outcomes in three critical areas: Revenue Acceleration, Cost Reduction, and Enhanced Customer Experience

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

Discover new ideas, insights & solutions

Healthcare CX Management
Healthcare CX Management

CXM for Healthcare

Resources

Whitepaper

Date

August 25, 2023

Download Whitepaper
Healthcare CX Management

In today’s dynamic healthcare landscape, the patient or member’s journey, from enrollment to renewal, has become paramount in defining the overall health experience. With rapidly evolving technology and increased emphasis on digital touchpoints, healthcare providers and payers must reinvent the way they interact, support, and foster relationships with their members.

In this comprehensive whitepaper, ‘CXM for Healthcare – Improve care outcomes, retention, and growth’, we delve deep into the intersection of healthcare and customer experience (CX), offering a clear roadmap for enterprises to transform and elevate the care journey.

As you traverse through its pages, you’ll gain insights into:

  • The revolutionary change that digital CX innovation is bringing to personalized care.
  • A detailed breakdown of pivotal moments in the member journey, from the initial enrollment to the crucial phases of renewal or disenrollment, the associated needs and challenges
  • Strategies and solutions to optimize member outcomes, leveraging the prowess of AI, analytics, and advocacy, while ensuring security and compliance.
  • Case studies showcasing how two major health plans harnessed next-gen CX solutions to improve advocate and member experiences.
  • Lastly, distill the learnings into five best practices, ensuring your organization can exceed member experience expectations.

We invite you to join us on this transformative journey.

Download the whitepaper for insights to envision and design the future of member experiences, integrating the best of technology with the warmth of personalized care.

CXM for Healthcare

CXM for Healthcare

CXM for Healthcare

Resources

Whitepaper

Date

August 25, 2023

Download Whitepaper
Healthcare CX Management

In today’s dynamic healthcare landscape, the patient or member’s journey, from enrollment to renewal, has become paramount in defining the overall health experience. With rapidly evolving technology and increased emphasis on digital touchpoints, healthcare providers and payers must reinvent the way they interact, support, and foster relationships with their members.

In this comprehensive whitepaper, ‘CXM for Healthcare – Improve care outcomes, retention, and growth’, we delve deep into the intersection of healthcare and customer experience (CX), offering a clear roadmap for enterprises to transform and elevate the care journey.

As you traverse through its pages, you’ll gain insights into:

  • The revolutionary change that digital CX innovation is bringing to personalized care.
  • A detailed breakdown of pivotal moments in the member journey, from the initial enrollment to the crucial phases of renewal or disenrollment, the associated needs and challenges
  • Strategies and solutions to optimize member outcomes, leveraging the prowess of AI, analytics, and advocacy, while ensuring security and compliance.
  • Case studies showcasing how two major health plans harnessed next-gen CX solutions to improve advocate and member experiences.
  • Lastly, distill the learnings into five best practices, ensuring your organization can exceed member experience expectations.

We invite you to join us on this transformative journey.

Download the whitepaper for insights to envision and design the future of member experiences, integrating the best of technology with the warmth of personalized care.

Whitepaper

August 25, 2023

Automation-Helps -Health-Plans-Improve-Agent-License

Automation Helps Health Plans Improve Agent License Management and Reduce Reporting Time by 75%

Enrollment

Case Study

March 30, 2023

Appointment-Setting-Campaign-for-Health-Plan-Exceeds-Goal-by-45%

Appointment Setting Campaign for Health Plan Exceeds Goal by 45%, Supporting Better Outcomes

Case Study

March 30, 2023

Transform Your Customer Experience, Act Now!

We are here to help

TALK TO US
Home
Outcomes
Insights
Careers
ESG
About Us
Contact

©2023 All Rights Reserved. ResultsCX

Privacy Policy
Site Map