Medicare Outsourcing Services That Improve Member Experience, Star Ratings & Operational Capacity

SkyCom delivers HIPAA-compliant, bilingual member services and back-office support for Medicare Advantage, Part D, Medigap, and D-SNP plans — improving CAHPS-driven member experience while reducing costs by 50–70% and absorbing AEP volume without permanent headcount.

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What Are Medicare Outsourcing Services?

Medicare outsourcing services involve delegating non-clinical, non-licensed administrative and member-facing functions to a specialized partner with Medicare program experience. These services help plans absorb seasonal volume, shorten answer times, improve CAHPS scores, and maintain the documentation discipline that CMS oversight requires.

Medicare Advantage organizations, Part D sponsors, Medigap carriers, D-SNP plans, MSOs, and TPAs increasingly rely on outsourcing partners to manage member services, claims support, grievance and appeal intake, provider services, and quality outreach — without compromising compliance or member satisfaction.

Complete Medicare BPO Services for Health Plans and Sponsors

A Medicare plan handles millions of member interactions a year, and CMS measures how well it handles them. Every call about a denied claim, a formulary change, or a provider directory error lands somewhere in the Star Ratings. SkyCom's Medicare outsourcing services help plans manage that volume through secure, HIPAA-compliant delivery teams aligned to US business hours.

01

Member Services
& Support

Non-licensed inbound and outbound member support covering benefits questions, ID cards, PCP changes, formulary and pharmacy inquiries, transportation and supplemental benefit navigation, and bilingual assistance for Spanish-speaking beneficiaries.

02

Claims & Billing
Support

Claim status inquiries, EOB explanations, premium billing and payment questions, LIS and Extra Help support, coordination of benefits research, and provider claim follow-up that reduces repeat contacts and abandoned calls.

03

Grievances & Appeals
Intake

Structured intake and documentation of grievances, coverage determinations, and appeal requests to your SOPs, with CMS timeline tracking and routing to your compliance team. Determinations always remain with the plan.

04

Back Office &
Quality Outreach

Enrollment and disenrollment processing support, provider directory validation, credentialing support, HRA completion outreach, care gap and medication adherence campaigns, and CAHPS-aligned member engagement.

THE SEASONAL PROBLEM

Solving the AEP Capacity Problem Without Permanent Headcount

Medicare is the most seasonal contact center workload in American healthcare. Annual Enrollment runs October 15 to December 7, and Medicare Advantage Open Enrollment follows from January 1 to March 31. Plans need multiples of their baseline capacity for roughly eight weeks, then carry that cost through a quiet spring. Hiring for the peak wastes money. Staffing for the average destroys your CAHPS scores exactly when CMS is measuring.

JUL – SEP

Ramp & Certify

Recruit, train, and certify surge teams on your plan benefits, systems, and scripts before volume arrives. Readiness testing completes before October 1.

OCT 15 – DEC 7

AEP Peak

Full surge capacity absorbs inbound member questions, plan comparisons, and non-licensed support while your licensed agents focus on enrollment.

JAN 1 – MAR 31

OEP & Onboarding

New member welcome calls, ID card and PCP setup, first-fill pharmacy issues, and the early-tenure problems that drive first-year disenrollment.

APR – JUN

Scale Down & Improve

Flex volume back to baseline. Redirect retained capacity into HRA outreach, care gap closure, and CAHPS improvement campaigns.

WHO WE SERVE

Medicare Organizations We Support

Every Medicare organization carries a different mix of CMS obligations, member demographics, and seasonal pressure. Our Medicare outsourcing services are tailored to each model with secure, scalable, HIPAA-compliant support that protects both member experience and your audit record.

Medicare Advantage Plans

Support Part C member services, benefits navigation, supplemental benefit questions, provider directory inquiries, and the CAHPS-weighted interactions that move Star Ratings across HMO, PPO, and regional contracts.

Part D Prescription Drug Plans

Handle formulary and tier questions, pharmacy network inquiries, prior authorization status, LIS and Extra Help support, coverage gap explanations, and medication adherence outreach tied to Part D Star measures.

Medicare Supplement & Medigap

Manage policy servicing, premium billing questions, claims crossover inquiries, plan benefit explanations, and retention support for supplement carriers serving Original Medicare beneficiaries.

D-SNP, C-SNP & I-SNP Plans

Deliver high-touch support for dual-eligible and special needs populations, including Medicaid coordination questions, care coordination scheduling, HRA completion outreach, and bilingual assistance where populations require it.

TPAs & Medicare Administrators

Extend third-party administrator capacity with claims support, eligibility inquiries, provider services, enrollment processing, and overflow member support across multiple plan clients.

MSOs, ACOs & Risk-Bearing Groups

Support attributed-member outreach, annual wellness visit scheduling, care gap closure campaigns, HRA completion, and patient engagement programs that improve quality performance under value-based contracts.

Why Medicare Plans Choose SkyCom

Medicare plans need an outsourcing partner that understands CMS oversight as well as customer experience. Our Medicare BPO services help organizations scale member support, protect quality scores, and manage seasonal volume without adding compliance risk.

Improve CAHPS-Driven Member Experience

Faster answer times, higher first-contact resolution, and bilingual specialists trained in Medicare terminology and the patience older beneficiaries deserve — the interactions CAHPS actually measures.

Absorb AEP Without Permanent Cost

Scale to surge capacity for the October–December peak and flex back down in spring. You pay for the volume you actually receive rather than carrying peak headcount year-round.

CMS-Aware Compliance Operations

HIPAA-compliant workflows, call recording and retention aligned to CMS requirements, documented grievance and appeal intake with timeline tracking, and audit-ready interaction logs.

US Time-Zone Alignment

LATAM delivery centers operate on US business hours. Escalations, compliance questions, and script changes get resolved the same day rather than overnight — which matters most during AEP.

Medicare-Specific Expertise

Specialists trained in Parts A through D, LIS and Extra Help, dual-eligible coordination, formulary structure, and the enrollment calendar — not generic healthcare agents reading a script.

How We Support Medicare Plans

Every Medicare program follows the same four-stage sequence, because CMS requirement mapping has to precede training, and training has to precede the first member call.

01

Compliance-First Discovery

Map HIPAA and CMS requirements, grievance and appeal SOPs, recording and retention obligations, and escalation paths before design begins.

02

Medicare-Specific Training

Specialists certified on your plan benefits, Medicare Parts A through D, formulary structure, dual-eligible coordination, and empathetic senior communication.

03

Secure Launch

Rapid rollout with encrypted tooling, restricted access, compliant call recording and retention, QA protocols, and audit-ready logging from day one.

04

Ongoing Optimization

Real-time monitoring, CAHPS-aligned quality scoring, root-cause review of repeat contacts, and coaching tied to the measures that move Star Ratings.

Ready to Transform Your Customer Experience?

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Testimonials

What Our Clients Say

Real results from partners who trust SkyCom for their LATAM nearshore customer experience.

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“Prescription customer service requires HIPAA compliance, pharmacy terminology, and genuine empathy. SkyCom's pharmacy team brings all three. Refill processing accuracy is 99.6% and patient complaints are minimal.”

Dr. Steven Ramos

Chief Pharmacy Officer, Specialty Pharmacy Chain

“Prior authorization for specialty drugs is a complex, high-stakes workflow. SkyCom built a PA support team with deep payer knowledge — our authorization turnaround dropped from 72 hours to under 24.”

Janet Forbes

VP Patient Services, Specialty Pharmacy Benefit Manager

“Patient adherence is our mission. SkyCom's outbound refill reminder team reached 34% more patients monthly than our previous vendor, driving measurable improvements in medication adherence rates for chronic condition management.”

William Okafor

Director of Patient Engagement, Mail Order Pharmacy

“We serve elderly patients with complex medication regimens. SkyCom's pharmacy support agents are trained to communicate clearly, patiently, and accurately — even when patients are confused or frustrated. Their quality scores are outstanding.”

Patricia Yee

Head of Patient Experience, Long-Term Care Pharmacy

Frequently Asked questions

Frequently Asked Questions

Find quick answers to common questions about partnering with SkyCom for LATAM nearshore services.

Can Medicare sales and enrollment be outsourced offshore?

No. Medicare marketing, sales, and enrollment require state-licensed, AHIP-certified agents appointed by the plan, and compensated lead generation or enrollment activity makes an organization a TPMO under 42 CFR 422.2260. SkyCom does not perform licensed sales. We deliver non-licensed member services, claims support, grievance and appeal intake, back-office processing, and quality outreach.

What Medicare functions can a nearshore BPO legally handle?

Non-licensed work: member services and benefits questions, ID cards and PCP changes, claim status and EOB explanations, premium billing, LIS and Extra Help inquiries, grievance and appeal intake and documentation, provider directory validation, enrollment application processing support, HRA completion outreach, care gap and adherence campaigns, and welcome calls.

How do you handle AEP and OEP volume surges?

We ramp and certify surge teams between July and September so they are production-ready before October 1. Capacity scales through the October 15 to December 7 Annual Enrollment Period and the January 1 to March 31 Open Enrollment Period, then flexes back to baseline in spring. You pay for actual volume rather than carrying peak headcount year-round.

How long must Medicare call recordings be retained?

Two tracks apply. Under the CY2027 Medicare Advantage and Part D final rule, marketing and sales call recordings carry a minimum six-year retention: audio for years one through three, then audio or a complete and accurate transcript for years four through six. Enrollment records remain subject to a separate ten-year retention requirement. We configure retention to your plan’s policy against both.

How does outsourcing member services affect Star Ratings?

CAHPS member experience measures carry significant weight in the CMS Star Ratings formula, and they capture contact center performance directly — ease of getting information, customer service helpfulness, and overall plan rating. Because Star Ratings use data one to two years old, service quality today affects quality bonus payments two cycles later.

Do you provide Spanish-language support for Medicare beneficiaries?

Yes. Native bilingual English and Spanish specialists are standard across all Medicare programs, with dedicated queues where member populations require them. This matters particularly for dual-eligible and D-SNP populations, where Spanish-language need is often high.

How do you ensure HIPAA and CMS compliance?

HIPAA-compliant workflows, SOC 2 Type II and ISO 27001 certified controls, encrypted systems, role-based access, restricted-desktop configurations, signed BAAs, compliant call recording and retention, and regular third-party audits. Specialists complete Medicare and privacy training before handling any beneficiary information.

How quickly can a Medicare program launch?

Most programs go live in 4–8 weeks covering CMS and HIPAA requirement mapping, Medicare-specific training, system integration, and QA setup. AEP surge programs should begin ramp by July to certify before the October 1 marketing window. Onboarding is managed by SkyCom at no additional cost.

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Customer Experience (CX) July 29, 2026