The problem
The plan needed HIPAA-aligned member services at a cost it could sustain, and its compliance function had blocked offshore delivery twice. Speed of answer, annual-enrolment abandonment and repeat contact on claims status were all weak, and the plan needed a partner whose privacy controls its own officers could physically verify.
What we did
- Trained and measured agents on a complete-answer protocol, not status-code reading
- Rebuilt quality scoring around completeness of disposition
- Established a compliance lead within the account and HIPAA-aligned handling
- Used the two-hour flight from Miami so the privacy officer could audit the floor in person
Results
Average speed of answer fell from 412 to 62 seconds, annual-enrolment abandonment fell from over 30% to 6.4%, and first contact resolution rose from 61% to 89%. Member satisfaction reached 96% and the operation recorded zero HIPAA-related audit findings. Nearshore proximity, not a document, is what changed the compliance function's position.
Metrics
Before and after
- Average speed of answer-85%
- Before412 sAfter62 s
- First contact resolution+28 pts
- Before61%After89%
- Member satisfaction+14 pts
- Before82%After96%
- Abandonment, annual enrolment
- > 30% → 6.4% (-79%)
- HIPAA-related audit findings
- n/a → 0 (Zero findings)
These metrics are shown as text only, because the client did not provide a comparable starting figure.
Bars compare the starting position with the measured result. Each row is scaled separately because the units are not the same.
Figures relate to the period stated and were provided by the client. They depend on that client's starting point, so they are not a forecast for another operation.
Our compliance function had blocked offshore twice. What changed their position was not a document, it was the fact that our privacy officer could fly to the site, walk the floor, and be back the same day.
What stayed in place
The complete-answer protocol and completeness-based quality model are now the plan's standard for member services, and the nearshore audit access remains a standing part of the compliance relationship.