The Challenge

Working closely with the client, ResultsCX identified process gaps that led to fragmented member engagement during ACA health plan enrollments, including limited contact channels, low digital adoption, and difficulty completing full-service enrollments at scale. These barriers slowed growth, increased support costs, and disrupted the member experience, highlighting the need for a solution that meets members on their preferred channels, promotes digital self-service, and improves completion rates. 

The Solution

ResultsCX introduced an AI-powered chat channel that strategically redefined the enrollment journey, providing guided support at key decision points while meeting customer expectations for convenience and clarity. This approach provides members with timely, contextual assistance to navigate complex questions, creating a more seamless and intuitive enrollment experience. 

• Members can complete plan comparisons, eligibility checks, and applications within a single digital journey, minimizing friction and drop-off. 
• Chat deflection increased voice-channel capacity, improving service levels, and reducing handle time. 

The Customer

A prominent health insurer offering affordable Health Insurance Marketplace plans that meet essential ACA requirements and support underinsured or uninsured individuals. Coverage spans multiple states and is delivered through regional partnerships, including preventive services, prescription coverage, specialty care, and virtual care. By providing members with tools, guidance, and support, the insurer simplifies care management and ensures they receive the right care at the right time.