Mastering Change in Benefits Administration: A Successful Partnership
Solix Case Study
Situation
A leading healthcare insurer faced increasing complexity in customer service operations—especially during peak enrollment periods. Seasonal hiring, training inefficiencies, and rising costs were straining their ability to maintain high-quality member support across both commercial and Medicare plans.
Objectives
- Enhance member experience through high-touch, compliant customer service.
- Streamline operations and reduce cost of service delivery.
- Scale quickly to meet seasonal demand and regulatory changes.
- Increase member retention and conversion through expert engagement.
Challenges
- Fluctuating staffing needs during open enrollment and Medicare seasons.
- Need for licensed agents to handle a wide range of inquiries and sales activities.
- Compliance with CMS regulations and evolving Affordable Care Act requirements.
- Educating new members—many unfamiliar with insurance concepts—on plan benefits.
- Maintaining data integrity, security, and consistent service quality.
Solution
- A trained, multi-client workforce ready to deploy in under a third of the typical onboarding time.
- Licensed agents trained to handle complex member questions and plan guidance.
- Outbound and inbound support, including educational outreach, appointment setting, and application assistance.
- Dedicated account-specific teams to personalize service delivery.
- Implementation of automated tools (e.g., agentless dialers) to increase efficiency and reduce manual effort.
- Support across multiple plans (Medicare Part C & D, vision, dental, small group, and under-65 exchanges).
Results
- 97–99.5% customer satisfaction sustained over a multi-year engagement.
- 99% accuracy in benefit quoting, data entry, and regulatory compliance.
- No KPI scores below 90%, including quality of tone, accuracy, and satisfaction.
- Reduced turnaround times from days to hours through automation.
- Successful execution of Annual Enrollment Period and Disenrollment campaigns.
- Continued program expansion into new product lines and customer segments.