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Licensed Healthcare Agents That Consistently Outperform

Purpose-built for health plans that want to win on new member acquisition — and keep the members they earn, all year round

Ranked #1 by 6 of 7 health plan clients in the 2024 AEP/OEP season. Exceeded enrollment goals on 9 of 12 client lines of business.
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#50

States covered

Active licensure across all 50 states for Medicare Advantage and ACA programs

86%

Effectuation rate

Major ACA marketplace insurer – scaled rapidly at maintained quality

95%

QA & compliance quality

Sustained at scale across all CMS monitoring benchmarks

30%

Conversion acceleration

Regional Blue Plan — stringent quality fully maintained

#1

Ranked by 6 of 7 health
plan clients, 2024 AEP/OEP

9/12

Client lines of business
exceeded enrollment goals

95%+

QA & CMS compliance
quality scores at scale

50%

Reduction in agent onboarding time

THE PROBLEM

Licensed agents are your most knowledgeable advocates.

Most plans use them for 10 weeks a year.

  • Compliance exposure from inconsistent seasonal offboarding and re-licensing every cycle
  • Re-training costs compound annually - agents lose product literacy between AEP seasons
  • Member care teams without plan literacy can't resolve - only respond - driving churn and hurting Star Ratings
  • High cost-per-enrollment (CPE) from repeated ramp-up friction, QA drift, and slower conversion at scale
Lloyd Fernandes, Practice Director, Everest Group.

As healthcare CXM evolves toward outcome-driven, technology-enabled operations, service providers must demonstrate the ability to integrate domain expertise with scalable digital capabilities. This is driving a shift toward models that embed analytics, and AI, to improve employee performance and member/patient experience outcomes. ResultsCX is well positioned to meet buyer needs through its broad healthcare value chain coverage, strong payer-centric and growing provider portfolio, and diversified global delivery model. Its investments in proprietary solutions such as SupportPredict™ and SupportPredict GENius™, along with capabilities in conversational analytics, real-time agent assist, and AI-driven training, have enabled more efficient and insight-led operations. These factors have contributed to its positioning as a Leader in Everest Group’s Healthcare CXM Intelligent Operations PEAK Matrix® Assessment 2026.

Healthcare CXM Intelligent Operations PEAK Matrix

OUR APPROACH

The Elite Licensed Agents Program

Purpose-built for health plans that want to win on acquisition and keep the members they earn.

01

Most Effective Cohort. Best Retention.

We operate the deepest bench of licensed healthcare agents in the industry. Our agent return rate is among the highest in the sector – meaning your plan benefits from agents who already know your products, compliance standards, and member expectations when the next season begins. No cold starts.
02

Persona-based training that creates advocates

Our Healthcare Persona Training goes beyond product knowledge. Agents learn the lived experience of a Medicare Advantage beneficiary, a Medicaid enrollee, or an ACA marketplace buyer – their anxieties, their language, their care needs. Grounded in our Five Essential Engagement Habits, this builds the empathy that turns enrollment calls into trust-building moments.
03

A year-round model that pays for itself

Our program doesn’t idle between enrollment seasons. We deploy licensed agents across member care, benefits navigation, effectuation follow-up, and retention programs – keeping them active, compliant, and deeply familiar with your plan. When AEP/OEP arrives, they’re ready. When it ends, the value continues.

AEP/OEP Acquisition

New member enrollment
CMS compliance

Effectuation

Activation follow-up
Revenue recognition

Member Care

Benefits navigation
FCR improvement

Retention

At-risk outreach
Loyalty building

Renewal Ready

Star Ratings lift
Next AEP advantage

TWO PROGRAMS. ONE ELITE AGENT POOL.

Built for enrollment season.
Designed to deliver all year.

365-DAY VALUE

Year-round member care & retention program

Deploy your licensed agents on the programs that protect your Star Ratings, reduce churn, and build genuine member loyalty – all year.

  • Benefits navigation & effectuation follow-up
    Newly enrolled members who don't activate are your highest churn risk. Our agents follow up, explain, and guide, driving effectuation rates that convert to revenue.
  • Empathy-led member care (FCR-focused)
    A licensed advocate understands coverage context. They resolve - not just respond. First-contact resolution improves, escalations drop, CSAT rises.
  • Proactive retention & loyalty outreach
    We identify at-risk members and deploy agents in outreach that combines plan literacy with genuine care, building loyalty that carries into renewal.
  • Star Ratings & member satisfaction impact
    Member experience is one of CMS's most heavily weighted Star Ratings dimensions. Every quality interaction builds a structural advantage in your ratings trajectory.

Annual Enrollment Period · Open Enrollment Period

When the season peaks, we're already ready

Scale confidently. Stay compliant. Hit your new member acquisition and member growth goals within CMS monitoring requirements.
  • Rapid, compliant ramp at scale
    Pre-licensed, pre-trained agents ready to handle CMS test calls from day one - state licensure, call audit compliance, and QA benchmarks maintained throughout the ramp.
  • Persona-based AEP/OEP sales training
    Consultative, needs-based enrollment conversations - not transactional ones. Agents understand the difference between a dual-eligible beneficiary and a first-time MA buyer, and are equally adept at guiding members through subsidy changes and plan discontinuations - the conversations that require the most trust and the clearest advocacy.
  • QA scoring & CMS compliance at every call
    Rigorous call audit programs, QA scoring frameworks, and CMS regulatory risk protocols protect your plan while maintaining member-first experience that builds trust.
  • Operational efficiency drives CPE down
    Agents who already know your products and quality standards mean faster ramp, fewer errors, and better conversion. CPE improves because quality doesn't degrade at scale.

DESIGNED FOR EVERY MARKET

Built for the complexity of every Health Plan market

Our persona-based training is calibrated for the specific population, compliance landscape, and member experience expectations of each plan type.

Medicare Advantage

MA sales and member care require agents who understand the nuances of benefits comparison, network navigation, and the emotional experience of aging into coverage decisions. Our licensed agents are trained to build trust with this population – supporting both new enrollment and year-round member engagement that directly impacts Star Ratings and renewal.
  • Star Ratings member experience scores
  • New member acquisition during AEP
  • Year-on-year renewal rates
  • Regulatory risk from CMS monitoring

#1

Ranked by the majority of our MA clients in the 2025 AEP/OEP season vs all competing vendors

9 of 12

Client lines of business exceeded their enrollment season goals with our MA licensed agent teams

ACA Marketplace

Marketplace buyers are often first-time insurance purchasers navigating a complex landscape of metal tiers, subsidies, and network constraints. Our agents are trained to simplify, not overwhelm – driving enrollment conversion while ensuring the member makes a decision that fits their life. The result: higher effectuation, lower churn, stronger retention.

  • Enrollment conversion rate (OEP)
  • Effectuation from first-time buyers
  • Post-enrollment member confusion
  • Early-year churn from poor plan fit

30%

Conversion acceleration for a large healthcare nonprofit operating in the ACA marketplace – with full quality compliance

86%

Effectuation rate at 95%+ quality – a major ACA marketplace insurer scaling rapidly for OEP

Medicare Traditional

Traditional Medicare beneficiaries navigating supplemental options need advisors, not sales agents. Our licensed advocates are trained to listen first, educate second, and connect members to the right choices – building loyalty to your plan before they ever have a claim. The result is a member base that trusts your plan enough to stay.

  • Member trust and plan loyalty
  • Supplemental plan understanding
  • Member confusion on coverage gaps
  • Escalations from uninformed members

50%

Reduction in agent onboarding and offboarding time for a leading health plan using our intelligent automation combined with licensed agent program
Our largest-ever Medicare seasonal ramp surpassed client conversion goals – demonstrating that scale and quality are not in tension when the program infrastructure is right.

Medicaid

Medicaid members often face the greatest barriers to understanding and using their coverage. Our persona training is specifically calibrated for this population – with communication approaches that reduce confusion, support effectuation, and reduce the administrative burden on your plan through better-informed member interactions.

  • Effectuation rates post-enrollment
  • Member understanding of benefits
  • Avoidable escalations and re-contacts
  • Administrative cost from uninformed calls

86%

Effectuation rate achieved for a major marketplace insurer, a result driven by post-enrollment licensed agent follow-up

95%+

QA and compliance quality scores sustained at full seasonal scale, protecting plan regulatory risk

PROOF IN PRACTICE

What Elite Licensed
Agents deliver for Health Plans

ACA Marketplace - Effectuation

Effectuation rate sustained at 95%+ quality while scaling rapidly

A major ACA marketplace health insurer needed speed and quality simultaneously. Our licensed agents delivered an 86% effectuation rate while maintaining 95%+ compliance and QA scores throughout a demanding ramp.
Read Case Study

Regional Blue Plan - Conversion

Conversion acceleration with zero compromise on compliance standards

A regional Blue plan needed to convert faster without letting quality slip. Our program accelerated conversions by 30% while meeting every regulatory and quality benchmark — including stringent CMS compliance requirements.
Read Case Study

Health Plan - Operational Efficiency

Reduction in agent onboarding and offboarding time through intelligent automation

A leading health plan was absorbing the full operational cost of seasonal agent ramps. Our intelligent automation solution cut onboarding and offboarding time by 50%, making every enrollment season faster, less expensive, and fully compliant.
Read Case Study

Medicare Advantage - Seasonal Ramp

Largest seasonal ramp surpasses Medicare Advantage conversion goals

Our largest-ever MA seasonal deployment didn't just hit target; it surpassed the client's conversion goals. Scale and quality are not in tension when the program infrastructure is built correctly from the start.
Read Case Study

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Your Licensed Agents Leave in December. Your Member Retention Problem Starts in January.

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See what the right Licensed Agent Program does for your plan.

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