Healthcare Payer Solutions
Simplifying Healthcare for Members
Making enrollment and benefits navigation easier through expert support, seamless access, and faster resolutions
Transform your customer experience
Discover how Everise delivers confidence through innovative, empathetic CX solutions that drive business growth.
Challenges
Operational scale without compromising experience
Healthcare payers face increasing pressure to control costs, protect quality performance, retain members, and improve long-term outcomes, particularly during Annual Enrollment Period (AEP) and Open Enrollment Period (OEP), as they navigate operational complexity and regulatory risk. Everise brings the infrastructure, expertise, and AI integration needed to scale enrollment and operations while safeguarding performance, compliance, and trust.
01
Delivering quality interactions at scale
Delivering quality interactions at scale
02
Inconsistent member satisfaction
Inconsistent member satisfaction
Member interactions vary across enrollment, benefits navigation, and service touchpoints.
When satisfaction drops, NPS declines, STARS and HEDIS performance suffer, leading to lower CMS quality bonus payments, reduced rebate flexibility, diminished broker confidence, and measurable erosion in retention and lifetime member value growth.
03
Limited AI infrastructure
Limited AI infrastructure
Many healthcare payers lack the operational readiness, governance, and workflow integration required to deploy AI effectively and responsibly. Amid rising pressure to improve operational efficiency and scale cost-effectively, fragmented AI efforts can introduce compliance risk, disrupt member interactions, and erode the human connection that drives trust and satisfaction.
04
Fragmented member journeys
Fragmented member journeys
Enrollment, authorizations, scheduling, and member services often operate across disconnected systems and teams. This fragmentation creates friction for members and limits payers’ visibility into performance, efficiency, and care outcomes, particularly for members managing complex or chronic conditions.
Impact
Built for High-stakes Healthcare Operations
With 15+ years of experience supporting healthcare payers across licensed and non-licensed operations, Everise delivers customized, scalable, performance-driven solutions built for before, during, and after peak enrollment seasons.
Trusted partner
Achieved with Medicare & Retirement members in AEP/OEP
Tenured agents
Year-over-year AEP agent return rate
Massive ramps
Agents added annually to support AEP/OEP
End-to-end Payer Operations
Full-spectrum payer support across Medicare, Medicaid, ACA, and Group products, delivered by licensed insurance agents and non-licensed healthcare agents, powered by EverAI technology and Everise College of Insurance
Licensed sales, acquisition, & renewal
Licensed and non-licensed enrollment operations spanning eligibility qualification, needs assessment, product recommendation, enrollment execution, verification calls, book-of-business management, renewal engagement, and benefit checkups, upsell, and personalized outreach
Member services
Provider services
Provider network management, provider qualification, authorizations filing and status updates, payment status, case management referrals, claims processing and status updates, appeals and grievances filing, and review of benefits and eligibility
Administrative services
Medical record retrieval, STARS and HEDIS support, back-office operations, reporting, and compliance governance
Transform your customer experience
Discover how Everise delivers confidence through innovative, empathetic CX solutions that drive business growth.
Insights
