CUSTOMER & MEMBER
SUPPORT SERVICES
CUSTOMER & MEMBER SUPPORT SERVICES
DRIVING MEMBER ENGAGEMENT WITH COMPREHENSIVE TPA SUPPORT SERVICES
Enhancing Member and Provider Experiences Through Seamless Support
Fusion CX offers comprehensive customer and member support services designed to optimize the member experience and ensure smooth communication between health plans, members, and third-party administrators (TPAs). Our services, including inquiry handling, care coordination, and payment reconciliation, are tailored to meet the unique needs of each member while helping TPAs enhance their operations.
With over 35 years of experience, Fusion CX combines advanced technology with empathetic service to provide timely, accurate support for both members and providers, ensuring satisfaction and fostering long-term relationships.
TRANSFORMING CUSTOMER & MEMBER SUPPORT THROUGH TAILORED SOLUTIONS
MEMBER SERVICES & INQUIRY HANDLING
Member Inquiries
Provide prompt and accurate responses to member inquiries related to benefits, claims, eligibility, and more.
Multilingual Support
Offer 24/7 multilingual support to ensure that all members, regardless of language, can access help when needed.
Comprehensive Support
Address all member concerns in a professional, empathetic manner to ensure satisfaction and resolution.
COMPLIANCE INQUIRY SUPPORT
Regulatory Compliance Assistance
Assist members and TPAs in understanding and adhering to healthcare regulations and guidelines.
Accurate Guidance
Provide members with clear, accurate information on compliance-related issues to avoid penalties and ensure proper care.
Documentation and Reporting Support
Help with compliance-related documentation, ensuring all requirements are met for audits and reporting.
Regulatory Updates and Alerts
Provide timely updates and alerts on changes to healthcare regulations, ensuring members and TPAs stay informed and compliant with evolving guidelines.
CARE COORDINATION FOR TPAS
Coordinating Care Across Providers
Facilitate communication and coordination between healthcare providers, ensuring members receive timely and appropriate care.
Seamless Communication
Bridge gaps in care by ensuring all parties—members, providers, and TPAs—are on the same page for optimal health outcomes.
Chronic Care Management
Offer support for members with chronic conditions by ensuring they receive continuous and coordinated care.
PREMIUM BILLING AND RECONCILIATION
Accurate Payment Posting
Ensure premium payments are posted correctly, improving financial accuracy and transparency.
Discrepancy Resolution
Resolve payment discrepancies efficiently to maintain member satisfaction and financial integrity.
Payment Reconciliation
Maintain accurate financial records and identify discrepancies quickly to support compliance and accountability.
CUSTOMER SERVICE FOR MEMBER INQUIRIES
24/7 Support
Offer 24/7 access to customer service representatives to handle member inquiries and resolve issues.
Comprehensive Service Channels
Support members across various channels, including phone, email, chat, and self-service portals.
Personalized Assistance
Provide tailored support for each member, ensuring their needs are met promptly and effectively.
Sentiment Analysis for Better Support
Use AI-driven sentiment analysis to evaluate member interactions, enabling service representatives to deliver more empathetic and personalized support.
AI SOLUTIONS FOR CUSTOMER & MEMBER SUPPORT
Arya (Member Support Coach)
Employs AI-powered inquiry handling to resolve routine questions swiftly, freeing agents for more complex tasks.
Conversational AI
Provides 24/7 self-service for members, reducing wait times and improving overall response speed.
Marketing AI
Enables proactive care coordination by identifying members at risk and facilitating timely, targeted outreach.
AI QMS
Automates payment reconciliation and flags billing discrepancies in real-time, ensuring accurate financial transactions.
MindSpeech
Elevates call clarity and compliance, enhancing member communications and ensuring a positive support experience.
THE FUSION CX-FACTOR
10.5K+
Skilled
Agents
PCI-DSS
Certified
25+
Language
Support
Ensured Business
Continuity
GET IN TOUCH
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WHY CHOOSE FUSION CX FOR CUSTOMER & MEMBER SUPPORT?
Comprehensive Support Services
Fusion CX provides a full range of support services, including member services, compliance inquiry support, care coordination, and payment reconciliation, ensuring seamless communication and service delivery.
Expert Care Coordination
We ensure that members receive timely, coordinated care through seamless communication between providers, members, and TPAs, leading to improved health outcomes.
Multilingual, 24/7 Support
Our healthcare call center offers round-the-clock, multilingual support to ensure that all members have access to assistance whenever they need it.
Efficient Payment Reconciliation
Fusion CX streamlines payment posting and reconciliation, reducing errors and ensuring financial accuracy for both members and providers.
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FAQS
FAQS
What customer and member support services does Fusion CX offer?
Fusion CX provides member services, compliance inquiry support, care coordination, payment reconciliation, and 24/7 customer service across multiple channels.
How does Fusion CX handle member inquiries?
We provide prompt, accurate responses to member inquiries and resolve concerns through a multilingual, 24/7 customer service call center.
What is the role of Fusion CX in care coordination for TPAs?
Fusion CX facilitates seamless communication between healthcare providers, members, and TPAs to ensure that members receive timely, coordinated care.
Can Fusion CX assist with compliance-related inquiries?
Yes, we provide comprehensive compliance inquiry support, ensuring that TPAs and members understand and meet healthcare regulations.
How does Fusion CX streamline payment reconciliation?
Fusion CX ensures that payments are posted accurately and reconciled efficiently, resolving discrepancies quickly to maintain financial integrity.
