What CX Really Means in Health Plan Call Centers – And Beyond the Phones
Why payers need to think about the member experience holistically and prioritize outcomes over transactions.
By Angie Lanasa, Senior Vice President of Operations, Imagenet
In healthcare, “CX” — customer experience — is often viewed through a narrow lens. Too often, CX is reduced to a handful of familiar metrics: Average Handle Time (AHT), First Call Resolution (FCR), or Net Promoter Score (NPS). But in an increasingly complex payer environment, these alone don’t capture the full picture of how a member experiences your brand.
True member customer service is far broader than the call itself. It lives in the unseen, often uncelebrated moments that shape the member journey—from the first enrollment form to credentialing a new provider to coordinating transportation to an appointment. When these workflows fail, the phone rings for all the wrong reasons.
In this blog, I’ll break down where member experience really happens—from the frontline to the back office—and why health plans must think beyond traditional call center metrics to deliver the seamless, trustworthy service today’s members expect.
The Traditional View of Contact Centers Falls Short
The traditional contact center model was built to solve transactional problems. Call comes in. Script is followed. Ticket is logged. Efficiency metrics are tracked. Rinse, repeat.
But for health plans, member frustration rarely starts at the moment of the call—it starts well before it. Success in today’s landscape depends on addressing the systemic causes of member dissatisfaction, not just responding to the symptoms.
Consider these common upstream CX breakdowns:
Inaccurate or incomplete enrollment data that triggers a domino effect of claim denials.
Ride coordination delays that result in missed care for transportation-dependent members.
Provider credentialing holdups that limit access to in-network care options.
Members don’t care whether the root of the issue is operational, technical, or regulatory. They care that the system worked—or didn’t.
A Broader View of What Influences Member Experience
A modern member experience is powered by the seamless orchestration of multiple teams, tools, and technologies. Some are visible; most are not. But each plays a vital role in building trust and reducing friction.
Key Functional Drivers of CX:
Frontline Member Support
Voice, SMS, chat, and email channels.
Tone, empathy, and accuracy in every interaction.
Enrollment Operations
Data entry, eligibility verification, and updates.
Prevents downstream issues with claims and access.
Ticket Queue Management
Ride coordination, benefit questions, follow-ups.
Time-sensitive tasks requiring precision and speed.
Credentialing Support
Provider intake and data validation.
Impacts member access, network integrity, and satisfaction.
When these areas are aligned, members rarely need to reach out. When they’re disjointed, the contact center becomes a catch-all.
The Expanding Definition of Healthcare CX
Leading health plans are fundamentally rethinking what it means to deliver a great experience. That shift is shaped by three intersecting pressures:
Rising consumer expectations:
According to Salesforce, 80% of customers say the experience a company provides is as important as its products and services.Operational transparency and accountability:
Regulators are emphasizing member rights to timely access and equitable service, requiring organizations to not only document but also improve internal processes.CX is now an enterprise-wide concern:
Leading health plans are tearing down silos between:Customer service
Operations
Claims
Compliance and quality
IT and digital transformation
The stakes are real: According to PwC, 59% of U.S. consumers will walk away after several bad experiences—even if they love the brand.
There needs to be a mind-set shift from "How fast did we answer?" to "How smooth was the entire journey?"
Delivering on the New CX Mandate
True CX transformation starts from the inside out. It's not about one metric or one channel—it’s about the cumulative impact of every touchpoint across the member lifecycle.
It requires:
Clean data.
Responsive and well-trained support teams.
Intelligent workflow design.
Operational agility.
And above all, a unified vision of service that prioritizes outcomes over transactions.
According to Forrester's 2024 US Customer Experience Index, CX quality among health insurers has dropped to a five-year low—highlighting the urgency for transformation. Notably, 10 major national health insurers recorded their lowest ratings during this period—underscoring the widespread challenges even well-established organizations face in meeting rising member expectations. Nearly one-third of insurers received “poor” ratings, putting pressure on leadership teams to rethink operations, improve retention, and protect long-term profitability.
This downturn underscores the urgent need for health plans to adopt a more holistic approach to customer experience, addressing not only frontline interactions but also the critical back-office operations that underpin member satisfaction.
Imagenet helps health plans elevate customer experience by optimizing the operational backbone that members never see—but always feel.
85% of calls answered in less than 30 seconds
99.8% data accuracy in enrollment processing
Automated workflows and ticket routing via Jetstream
Credentialing and provider data support to protect access and reduce friction
For health plans ready to evolve CX from the inside out, Imagenet is here to help turn that vision into reality.
What would it take to make your member experience truly seamless?
Angie Lanasa, Imagenet’s Senior Vice President of Operations, is a recognized subject matter expert in healthcare contact center strategy. With more than two decades of experience leading large-scale teams across the U.S. and the Philippines, Angie specializes in designing high-performing service models that drive measurable improvements in member satisfaction. Her expertise spans omnichannel support, claims adjudication, and operational transformation—making her a trusted advisor to health plans seeking smarter, more integrated CX delivery.