Fusion CX offers comprehensive customer and member support services designed to optimize the member experience and keep communication smooth between health plans, members and third-party administrators (TPAs). Our services, including inquiry handling, care coordination and payment reconciliation, are tailored to the needs of each member while helping TPAs run leaner, more responsive operations.
With more than 22 years of experience, Fusion CX combines advanced technology with empathetic service to give members and providers timely, accurate answers. Our HIPAA-compliant teams handle benefits, eligibility and claim status questions across phone, email, chat and self-service portals, in the language each member prefers through our multilingual support.
Member support works best when it sits next to the rest of the TPA operation. Our agents work alongside claims support and enrollment and billing teams, so a premium question, a claim question and a coverage question can all be settled in one conversation, building long-term relationships with the members you serve.
Four connected workstreams for TPAs: member inquiries, compliance questions, care coordination and premium reconciliation.
Prompt, accurate answers on benefits, claims, eligibility and more, with every concern handled professionally and empathetically through to resolution.
Round-the-clock access to trained representatives, so every member can get help when they need it, regardless of language.
Clear, accurate guidance that helps members and TPAs understand healthcare regulations and guidelines, avoid penalties and access proper care.
Help with compliance documentation for audits and reporting, plus timely alerts when healthcare regulations and plan guidelines change.
Communication between providers, members and TPAs kept in step, closing gaps so members receive timely and appropriate care.
Scheduling, reminders and follow-up calls for members with chronic conditions, supporting continuous, coordinated care alongside their clinical teams.
Premium payments posted correctly, records reconciled and discrepancies resolved quickly to support compliance, accountability and member satisfaction.
Phone, email, chat and self-service portals in one history, with AI sentiment analysis guiding more personalized, empathetic responses.
A TPA answers for many plans at once, each with its own rules. Here is how we keep answers consistent across all of them.
We load benefit summaries, eligibility rules, networks and escalation contacts for each employer group, then certify agents on them before they take calls.
Routine benefit and ID card questions stay with front-line agents, while compliance, billing and care coordination requests go to trained specialists.
Claims, billing and care coordination issues move to the right team with notes attached, so members never have to repeat their story.
Weekly reports show contact reasons, sentiment trends and open issues by group, giving TPAs clear data to share with their plan sponsors.
Omind products sit inside every member support program. People stay in control of every decision about coverage, care or payment.
Scores member calls and chats for accuracy, HIPAA handling and sentiment, flagging billing discrepancies and coaching needs as they happen.
GenAI voice agents offer members 24/7 self-service for ID cards, eligibility checks and claim status, cutting wait times with a clean handoff.
Real-time accent harmonization and noise reduction keep benefit, billing and compliance conversations clear, so members understand every detail the first time.
Complete member coverage with the controls a regulated TPA program needs.
Member services, compliance inquiries, care coordination and payment reconciliation delivered by one connected team.
Seamless communication between providers, members and TPAs that helps members get timely, coordinated care.
Round-the-clock help in 28 languages, so every member can reach assistance whenever they need it.
Streamlined premium posting and reconciliation that reduce errors for members, providers and plan sponsors.
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 seasonal peaks.
What happened when health plans and healthcare companies handed member communication to Fusion CX.
Tell us about your member volumes, plans and channels. A healthcare CX specialist will follow up with a scope, ramp plan and pricing.
Guides for TPAs and health plans improving member experience.
The questions TPAs ask us most often about customer and member support.
Fusion CX provides member services, compliance inquiry support, care coordination, payment reconciliation and 24/7 customer service across multiple channels, including phone, email, chat and self-service portals. TPAs can use one service or the full set, delivered by the same HIPAA-compliant team.
We provide prompt, accurate responses to member inquiries about benefits, claims and eligibility, and resolve concerns through a multilingual, 24/7 customer service call center. Agents handle every member professionally and empathetically, and route complex issues to the right specialist team.
Fusion CX facilitates seamless communication between healthcare providers, members and TPAs, so members receive timely, coordinated care. We also support members with chronic conditions through scheduling, reminders and follow-up, working alongside their clinical teams.
Yes. We provide comprehensive compliance inquiry support that helps TPAs and members understand and meet healthcare regulations. That includes clear guidance on compliance-related questions, help with documentation for audits and reporting, and timely updates when regulations change.
Fusion CX makes sure premium payments are posted accurately and reconciled efficiently. We identify and resolve discrepancies quickly, maintaining accurate financial records that support compliance, accountability and member satisfaction for both members and providers.
