Health Insurance & Payers

Member experience and operational solutions for health insurers

Health plans need a partner who understands the full member journey — how enrollment, onboarding, compliance, and engagement all connect — and uses that insight to create more seamless, supportive experiences at every step.

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97
%
Service levels sustained vs. a client baseline below 80%
1.2
M
Operational savings with 48% agent turnover reduction

2.5 → 5.0

CMS Star Rating in 12 months — CAHPS-driven, compliance-grade

CASE STUDY

How a Medicare Advantage plan rebuilt member trust — and earned their Stars back

CAHPS scores don't improve by accident. They improve when every member interaction is designed around how members actually experience it — not just how the plan intends it.

  • 1 Contact center protocols redesigned around CAHPS survey dimensions
  • 2 Proactive HEDIS gap closure outreach reduced missed preventive care touchpoints
  • 3 100% call recording, CMS test call readiness, audit-ready documentation
  • 4 Full Star Rating reversal within a single measurement cycle
Read the full case study
Member Experience Services

Built around the full member lifecycle

Ten integrated capabilities — from pre-enrollment through ongoing care. Each designed to compound the value of the others.

Marketing campaigns, enrollment likelihood modeling, and print production timed to the Annual and Open Enrollment cycles

Welcome kit assembly, ID card production and distribution, welcome calls, and new member setup.

Extended-hours contact center coverage, AEP and Medicaid redetermination surge capacity, and overflow support for peak periods.

HRA outreach, HEDIS gap closure campaigns, immunization reminders, and Medicaid redetermination outreach.

Dual-eligible acquisition campaigns, Medicaid/Medicare crosswalk prospect identification, compliance-grade member care, and welcome kit fulfillment.

Omnichannel benefits explanation, claims status, provider and referral inquiries, and app and portal support.

ACA-mandated and condition management kit assembly and distribution, with member eligibility validation and integrated fulfillment. Pay-on-dispatch inventory model with Harte Hanks absorbing obsolescence risk.

Structured intake and routing, deadline tracking, audit-ready documentation, and CMS and Stars risk mitigation.

Language-specific agent routing, translated materials, and culturally adapted outreach for Medicaid, D-SNP, and PACE populations.

100% call recording, CMS test call readiness, and continuous QA monitoring.

If any of this feels familiar, you're not alone.

Whether it's AEP surge, CMS compliance, or member experience gaps, we've helped plans navigate it before. Let’s see if we’re a fit.

Our approach

A different kind of partner for health plans

Because we work across the full member journey, we see how every function connects — from enrollment to engagement. That means even when we’re focused on one area, our approach is informed by the bigger picture.

Even when running a single function for a plan, Harte Hanks approaches it with awareness of how it connects to everything else. A contact center interaction reveals something about onboarding materials. Onboarding data informs retention campaigns. Plans get a partner whose reporting extends beyond the contracted scope.

We understand what it means when an abandoned call happens in October. Our teams know how CAHPS surveys work, why AEP surge capacity is a compliance issue as much as an operational one, and how a Star Rating movement translates into bonus payment consequences.

From large-scale BCBS relationships to regional Medicare Advantage and individual market plans, Harte Hanks has delivered member-facing functions under real operational pressure. The experience compounds: each engagement makes the next one more informed.

We use AI to extend what human agents can do: predicting contact volume before it peaks, surfacing compliance risk in real time, personalizing member communications at scale. The technology does not replace human judgment — it makes it faster, better informed, and more consistent.

Relentlessly human

CAHPS scores and Star Ratings improve when every touchpoint – call, letter, kit. outreach – is designed around how members actually experience it.

Powered by technology

Al extends what our agents can do: predicting volume before it peaks, surfacing compliance risk in real time, scaling without degrading service quality.

Driving results

Every engagement measured against outcomes health plans track: Star Ratings, cost-per-interaction, service levels and member lifetime value.

The financial case

Member experience is a margin lever, not a cost center

Margins are tightening across health insurance. The plans pulling ahead aren’t cutting corners — they’re operationalizing member experience.

Because when it’s done right, the impact shows up everywhere. Stronger onboarding lowers call volume. Proactive HEDIS outreach prevents compliance issues. Built-in AEP surge capacity eliminates reactive, high-cost staffing decisions.

Function by function, the gains add up — reducing cost-to-serve across the entire organization.

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$1.2M

Operational savings — federal health plan, 5.5M participants

48%

Operational savings — federal health plan, 5.5M participants

20 min

Saved per call through AI-assisted analytics

2 → 58

Agents scaled for 100K-call AEP surge

Featured report

Closing the Gap

Insights shaped by real-world experience — drawn from running contact center, enrollment, fulfillment, and AEP surge operations.

The Profitability Case for Member Experience

No competitor can replicate this perspective. Our data doesn’t come from theory — it comes from doing the work, day in and day out.

  • How close most plans already are to the CAHPS tier boundaries that determine bonus payment eligibility
  • Why relative scoring in a still-disrupted market creates opportunity
  • How the member experience delivered in AEP 2027 will be vital for strategic growth
  • Where the marginal gains in member experience come from
Explore the full report

Ready to see what this looks like for your plan?

Talk to a specialist who understands the the operational realities you face
— not just the pitch deck.

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Resources

Proof and perspective for health plan leaders

View all health insurer resources
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See how we perform for plans like yours

Talk to a health plan specialist

Tell us a little about your organization. We’ll come prepared with relevant experience and zero generic sales material.

Frequently asked

Questions health plan leaders ask us

Better member experience reduces unnecessary call volume — when onboarding materials are clear, members don't call to ask what they mean. Proactive engagement closes HEDIS gaps before they become compliance issues. Each function, done well, reduces friction and cost downstream.

Yes — and this is a core competency. We scaled from 2 agents to 58 in response to a 100,000-call surge, then wound back to 10 as volume decreased. AEP surge readiness is built into how we structure every health plan relationship.

We measure experience quality and business outcomes together: CAHPS scores, Star Rating trajectory, cost-per-interaction, service level attainment, and member lifetime value. We report on the metrics health plan leaders actually track.

This is built into how outreach runs day to day. It’s structured around how members actually respond and follow through, not just how programs are designed on paper. Done well, it reduces missed care, supports compliance, and prevents gaps from becoming larger issues later.

No. Our work spans enrollment, onboarding and fulfillment, member services, compliance and appeals, and proactive engagement. Much of this sits within broader healthcare BPO models, where these functions run together rather than in isolation – giving us the systemic view that makes each one more effective.

Most vendors operate one function in isolation. We work across enrollment, contact center, fulfillment, and compliance — often for the same plan. Our reporting is informed by the connections between functions, not just the one we’re contracted to run.

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