Health Plan Expands by Outsourcing
Healthcare
Case Study
The Overview
Health insurance company providing medical, dental and vision plans to its members sought a HIPAA compliant BPO partner to help with its expansion into different states.
The company offers a range of products including group, individual, and senior health plans, as well as dental, vision, and telemedicine services.
The Challenge
A not-for-profit health insurance company founded in the 1930's sought to expanded it full services across the MidWest and South but was reluctant to invest millions of dollars in call centers and additional staff. It needed a flexible solution, skilled bilingual agents and a trusted healthcare partner.
The Solution
Our portfolio partner provided knowledgeable member care representatives who delivered concierge-level support to the client’s members across the USA.
The program was a cost-effective solution, utilizing nearshore bilingual (English Spanish) agents for customer care and offshore claims processing to keep costs low. This allowed the carrier to maintain best-in-class service while offering affordable healthcare plans.
300,000+ Members
4.5 Stars
Member Satisfaction
The Successful Outcome
Our BPO partner guided members through the enrollment process, answered eligibility questions, assisted with provider searches, and resolved any issues. For care management, they handled prior authorizations, coverage reviews, and prescription assistance.
​
They also ensured timely claims processing, completed data entry, coordinated benefits, and managed provider correspondence.