The Challenge

Year after year, the insurance provider faced challenges in delivering high-quality member support while managing significant seasonal fluctuations in call volume. They needed a stable, year-round agent workforce to meet member and regulatory requirements along with the ability to scale quickly during ACA open enrollment. Given the limited pool of licensed talent, the organization lacked the flexibility to scale agent capacity, and meeting temporary demand resulted in costly, complex staffing ramp-ups. They chose to partner with ResultsCX for its industry-leading CXM capabilities.

The Solution

Leveraging its fast, flexible engagement model, ResultsCX recruited, trained, and deployed licensed agents across remote and on-site delivery models. What began as ACA Marketplace support 13 years ago expanded over time to include Medicare, D-SNP, and CMS Test Season operations, driving consistent sales growth year-over-year.

• Instructional training design: Delivered interactive Medicare content leveraging a combination of brick and mortar and virtual resources.
• Flexible staffing: Staff agents year-round, rapidly scale during peak enrollment, and ramp down subsequently.
• Strategic handoffs: Managed enrollments with licensed agents and seamlessly handed them off to non-licensed agents, ensuring compliance, efficiency, and continuity.

The Customer

A leading American nonprofit healthcare company and one of the largest health insurers in the United States committed to improving health outcomes for millions of members through affordable, high-quality coverage. By combining clinical innovation and community focus with operational excellence, the insurer delivers trusted healthcare solutions across markets.