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Healthcare
Scale Operations and Reduce Compliance Risk With CXBPO™ for Healthcare
Enrollment surges and authorization backlogs slow response times and put member retention at risk. HIPAA-trained teams from iQor resolve member inquiries and authorizations faster, protecting revenue. Serving 7 of the top 10 health insurance companies. Deployed in 30 days.
Healthcare Payers Trust iQor to Deliver Measurable Results
500%
scalability to staff open enrollment fully
96%
of outcomes achieved across all KPIs.
30 days
from signed agreement to a fully operational, HIPAA-trained team.
Open enrollment lasts eight weeks; payroll runs all year. Carry a full team and you pay for agents you don't need through ten quiet months. Triple your headcount and quality falls during the window that matters most. You've already optimized every other cost category, so labor is the only place left to find real savings. But most plans keep hiring because they staff on volume assumptions, not interaction data that shows how many calls are repeat contacts or could have been self-served.
HIPAA-trained outsourcing teams deliver 500% scalability for open enrollment and right-size the moment it closes. iQor specialists, trained for payer operations, answer members faster and achieve more resolutions on the first call. infinityAiQ™ analyzes 100% of your interactions, not a 2% sample, showing you where your agents' time actually goes and which calls could be automated. One regional health plan has partnered with iQor for 13 years, tripling its team every open enrollment while holding service quality steady. Results like these are why iQor is the No. 1 partner for 90% of multi-vendor clients.
Trusted by Leading Healthcare Brands
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Services
Support the Full Member Journey With Payer Outsourcing Services
Support the Full Member Journey With Payer Outsourcing Services
Member needs span enrollment, claims, authorizations, appeals, and more — and every handoff between departments adds delay and frustration. iQor handles the full member lifecycle under one HIPAA-compliant team, so members stop getting passed around and issues get resolved in fewer touches. HITRUST and SOC 2 Type II certifications mean member data stays protected at every step.
Member Support & Engagement
Members get 24/7 omnichannel support across voice, chat, email, and SMS, covering issues from onboarding and benefits to billing and portal access. One team handling the full range of member needs means faster answers and fewer repeat calls.
Enrollment & Benefits Support
Plan selection guidance, eligibility verification, and benefits education delivered through open enrollment and year-round. Capacity that flexes with seasonal volume means new members get clear answers at the moment they're choosing a plan.
Claims Support & Adjudication Assistance
Claims status inquiries, Explanation of Benefits clarification, and adjudication assistance that help members understand what's covered and why. Clear, accurate claims communication cuts repeat calls and the disputes that escalate into appeals.
Prior Authorization, Appeals & Grievances
Prior authorization processing, appeals management, and grievance documentation completed within regulatory timelines. Timely, well-documented handling keeps members from facing care delays and shields your plan from compliance exposure.
Provider Support Services
Claims status, eligibility checks, and authorization questions handled for in-network providers, so their offices spend less time on hold. Smoother provider interactions strengthen network relationships and ease administrative strain.
Care Coordination & Member Outreach
Proactive outreach connects members to wellness programs, health risk assessments, and care coordination that close gaps in care. Engaged members stay healthier and more loyal, supporting both quality measures and retention.
Awards & Recognitions
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Here's What Working With Us Looks Like in Practice
Knowledgeable
Specialists are trained in HIPAA protocols, member workflows, and payer regulations before they take a single call. Built for the compliance demands of health plan operations, not reassigned from a simpler vertical.
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Consistent
Operations leadership knows your enrollment cycles, claims workflows, and CMS obligations. One point of ownership keeps execution tied to your member experience and retention goals.
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Visible
Real-time reporting on member satisfaction, claims trends, authorization turnaround, and call drivers across every channel. infinityAiQ™ surfaces friction sooner, so your team can act before it reaches members or regulators.
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Fast
Deployment in 30 days, with a HIPAA-trained team integrated into your member platforms and calibrated on your protocols from Day One. Speed matters when enrollment volume and member needs don't wait.
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Tell Us Your Payer Challenge, and We'll Show You How We've Solved It Before
Share your toughest enrollment, claims, or authorization bottleneck, and we'll connect you with the right team and deployment plan.
Case Studies & Trends
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Every stage powered by AI — from first hire to higher performance.
Start with insights. Build toward outcomes. Scale what works.
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FAQ
Frequently Asked Questions
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