For health plans & payers
AI plus human intelligence for the modern payer member services org. Built for Star Ratings, HIPAA-aware, deployed on the contact-center stack you already run.
Each half-star of Medicare Advantage bonus ties to roughly $300 in revenue per member per year, and the inputs have moved from claims data into the member experience itself. CSAT, complaint patterns, network adequacy and access timeliness are all evidenced inside the calls. At the same time, grievance volume is rising across MA, commercial and pharmacy benefits, and CMS expects full-call evidence on resolution. Sample-based QA was never built for this. The 2 to 5% of calls a traditional QA team listens to is now the smallest part of the regulator and revenue surface a payer is judged on.
HIPAA-aware Auto-QA on 100% of voice and digital interactions. Custom scorecards for grievance, appeals, benefits explanation and Star Ratings drivers.
Real-time guidance on plan benefits, formulary lookup and prior authorization steps. AHT comes down while first-contact resolution accuracy goes up.
Topic and theme detection across the full member panel. Rising grievance precursors, network adequacy issues and CMS-flag categories surface daily.
Evidence-linked coaching with HIPAA-aware redaction. Supervisors review the actual moments that drove or hurt CSAT, not aggregate dashboards.
We replaced a sampling-based QA process with full-coverage Auto-QA. Our supervisors now spend their time coaching the moments that matter, not chasing the 2% they happen to listen to.
Move from a 2-5% sample to scoring every member conversation. Wire CSAT and grievance signal directly to evidence-linked coaching. Three numbers shift, on the same supervisor headcount.