Compliance Intelligence

Are your Agents CMS compliant? SEC has conducted more than 25,000 Medicaid and Medicare Managed Care audits covering Marketing | Sales Compliance and Member service.  Our Face-to-Face, Events or Call Center Intelligence Solutions have consistently facilitated plans in maintaining enrollment privileges with CMS and SDOH.

  • Avoid legal issues and ensure compliance
  • Identify key performance indicators that drive patient satisfaction
  • Provide ongoing training tools to measure and manage more effectively
  • Maintain a positive brand image

Service Evaluation Concepts provides Front-Line Business Intelligence that will measure “the Designed Member Experience” for any Medicaid and|or Medicare Plans throughout the United States.  SEC has conducted more than 25,000 audits in this industry covering the discipline of Marketing|Sales for Compliance and Customer Service.  Our Front-Line Business Intelligence Solutions have consistently facilitated plans in maintaining enrollment protocol privileges of CMS and|or SDOH.

Each member of our panel of more than 250,000  Brand Agents (Undercover Compliance Agents) must successfully complete plan-specific training and certification before conducting an evaluation.  SEC customizes evaluation collateral so that it incorporates both organizational needs, and CMS’ regulatory requirements.  Further, SEC’s BI Reporting & Dashboard Gallery provides access to real time audit data, allowing you to monitor compliance with CMS’ suggested protocol and best practices to develop effective and relevant training.  No matter what your objectives, we will partner with you to develop a customized program that will provide actionable intelligence using state-of-the-art technologies and proven research methodologies.

We help our clients to:

  • Ensure CMS, MIPPA and State compliance to avoid legal issues and maintain a positive brand image
  • Identify key performance indicators that drive member and patient satisfaction
  • Align organization-wide focus on creating superior service at every touch point in the member pathway
  • Provide ongoing training tools to measure and manage more effectively
  • Improve agent sales and relationship building skills

Serving many sectors and situations in the healthcare industry including:

  • Health Insurance and Managed Care Providers
  • Hospitals and Clinics
  • Assisted Living Facilities
  • Sales and Training Events
  • In-home Meetings
  • Community Meetings
  • Medicare / Medicaid Sales
  • Customer Support Call & Message Centers

We offer customized programs using the following methodologies:

  • Mystery Shopping Programs
  • Operational Compliance Audits
  • Competitive Benchmarking
  • Customer Feedback Surveys
  • Audio Assist – Scope of Appointment Call Recording
  • Call Track Call Center Call Monitoring and Recording
  • Ad Track Marketing and Sales Management Tracking and Monitoring Tools
  • Smart Agent Mobile Information Gathering Tools
  • Pulse Online Reputation Monitoring

Compliance Builder Packages

Not looking for an ongoing program? Not sure exactly what you need? Let our compliance experts put together an introductory package of services at a price you can afford, with no long-term commitment. Please call 516.576.1188 x.3530 or email us at solutions@serviceevaluation.com for more information.

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