Fusion CX offers a complete suite of health plan call center services designed to streamline operations, optimize care delivery and enhance both member and provider experiences. Our solutions cover the entire health plan lifecycle, from sales and quoting to core claims processing, medical management, customer service and more.
With decades of experience as a Medicare BPO, we deliver tailored solutions that help health plans improve operational efficiency, lift member satisfaction and stay compliant through every enrollment season and regulatory change.
From member onboarding and provider credentialing to fraud detection and digital support, our end-to-end health plan BPO services reduce administrative burden, drive cost savings and improve outcomes for health plans, providers and members, across omnichannel and multilingual programs.
Pick one workstream or connect them all. Each links to a dedicated program built for health plans and their members.
Lead generation, annual enrollment programs, licensed agent outreach and customized quoting that help prospective members choose the right plan.
Compliance-based Medicare enrollment, AEP outreach and member education that reduce attrition and keep members informed through every enrollment window.
Account setup, premium billing, onboarding, benefit management and preventive care outreach, with 24/7 support by phone, email and chat.
Provider inquiries, credentialing, data management, education and fraud, waste and abuse detection that keep your network accurate and engaged.
Non-clinical support for care, utilization and wellness management programs that improve care quality and reduce unnecessary costs for members.
Claims adjudication, adjustments, re-pricing, payment reconciliation, dispute resolution and HCC coding support for accurate, timely reimbursements.
Claims inquiries and billing assistance for providers, helping resolve issues quickly so reimbursements stay on schedule and disputes stay low.
Help with telehealth access, health plan apps and member portals, so members and providers can use digital tools with confidence.
Members do not see departments, they see one plan. Here is how we connect the stages that usually sit in separate silos.
Licensed agents handle lead follow-up, quoting and enrollment calls on approved scripts, with seasonal capacity planned well before enrollment windows open.
Welcome calls, ID card and portal help, and benefit education in the member's language, so new members know how to use their coverage.
Provider inquiries, credentialing, adjudication and reconciliation run on shared procedures, so a claim question and the claim itself match.
Preventive care outreach, renewal conversations and AI QMS insights feed back into scripts, training and plan communications every month.
Omind products sit inside every health plan program. People stay in the loop on every decision that affects coverage, claims or care.
Automates audits and compliance checks on member and provider interactions, maintaining regulatory accuracy, HIPAA compliance and high service quality standards.
GenAI voice agents for eligibility checks, benefit questions, claim status updates and appointment scheduling, with a clean handoff to a person.
Real-time accent harmonization and noise cancellation keep member and provider calls clear, professional and easy to follow on every line.
Lifecycle coverage with the controls, languages and scale a regulated health plan needs.
Services that cover the entire health plan lifecycle, from sales and quoting to claims processing.
AI and automation streamline claims, quality checks and routine inquiries so teams focus on members.
Smooth member onboarding, education and support, alongside streamlined provider engagement and reimbursement.
Round-the-clock member and provider support in 28 languages across phone, email and chat.
PHI handling, access controls and audit trails on every workflow, with PCI DSS and ISO/IEC 27001:2022.
40+ delivery centers in 13 countries keep member lines open through outages and enrollment peaks.
What happened when health plans and healthcare organizations handed member communications to Fusion CX.
Tell us about your members, providers and enrollment calendar. A health plan CX specialist will follow up with a scope, ramp plan and pricing.
Guides and perspectives for health plan leaders running member and provider support.
The questions health plans ask us most often.
Fusion CX offers a wide range of services for health plans, including sales and quoting, member services, provider support, medical management support, core claims processing, customer service and revenue cycle management. Health plans can outsource a single workstream or connect several into one program that covers the full member lifecycle.
We combine advanced technology, expert licensed agents and rigorous compliance checks to make sure all services meet regulatory standards. Approved scripts, required disclosures, HIPAA-compliant data handling and AI QMS reviews of member and provider interactions help surface gaps early, long before an audit.
Yes. We offer claims adjudication, claims re-pricing, payment reconciliation, claims adjustments, payment dispute resolution and HCC coding support to ensure accurate and timely processing. Our teams also handle provider claims inquiries, so questions about a claim are answered by people who understand how it was processed.
Fusion CX enhances member engagement through personalized education, preventive care outreach and 24/7 multichannel support by phone, email and chat. Onboarding calls, benefit explanations and reminders in the member's preferred language help members use their coverage and stay with the plan.
Yes. We support Medicare Advantage and other health plans with licensed agent outreach, compliance-based enrollment, AEP and open enrollment programs, and member onboarding. Staffing, training and scripts are planned ahead of each enrollment window so routine member service is not squeezed out when volumes peak.
Fusion CX combines decades of healthcare expertise, AI-driven solutions and a member-first approach to help health plans deliver exceptional service while optimizing operations. With 40+ delivery centers in 13 countries and support in 28 languages, we scale with your membership and enrollment calendar.
