Delivering Healthcare
Payer Services, at Scale
Healthcare Payer Services That Improve
Member Experience and Compliance
Ameridial delivers scalable healthcare payer services designed to strengthen member engagement, streamline provider interactions, and support regulatory compliance. Our payer-focused capabilities span enrollment and eligibility, provider support, and claims-related functions. With deep healthcare payer operations experience, we help health plans reduce administrative burden while improving service quality and operational continuity—whether supporting national insurers or regional health plans. Ameridial tailors solutions to drive measurable improvements across payer performance outcomes.
Our payer support operations are enabled by trained teams, secure infrastructure, and technology-driven workflows. We support end-to-end payer functions, including member onboarding, claims support, provider services, and fraud, waste, and abuse mitigation. This structured delivery model promotes cost efficiency, regulatory alignment, and scalable responsiveness—helping health plans enhance member trust and operate effectively in a competitive payer environment.
Who We Serve
Medicare Advantage Plans
Support Medicare Advantage enrollment, outreach, risk adjustment, and Stars performance across AEP and OEP cycles.
Medicaid & Managed Medicaid Plans
Support eligibility, redetermination, and member outreach while addressing social needs through coordinated assistance.
ACA Exchange / Health Plan Marketplace
Support enrollment, subsidy guidance, billing assistance, and member education aligned with ACA coverage requirements.
Commercial Health Plans
Support scalable member services, group onboarding, benefits education, and claims assistance for plan operations.
Services Offerings for
Healthcare Payer Support
Ameridial supports a wide range of healthcare payers with specialized member engagement, administrative, and compliance-driven support services. Our teams bring deep payer expertise—spanning Medicare Advantage, Medicaid, ACA Marketplace, and commercial plans—to help organizations streamline operations, enhance member experience, and maintain regulatory confidence across every interaction.
Enrollment and Eligibility
Guide members through verification, enrollment, and benefits eligibility with accuracy and precision.
Member Onboarding & Education
Educate new members on plan benefits, digital access, and care pathways for confident plan adoption.
Benefit Management
Help members navigate coverage details, costs, and plan benefits with clarity and ease.
Claims Administration
Process, track, and resolve claims efficiently with transparency and turnaround control.
Member Support Services
Resolve inquiries, maintain accurate records, and deliver empathetic issue resolution.
Provider Customer Service
Support provider networks with eligibility checks, referrals, and portal navigation assistance.
Provider Claims and Billing
Support claim submissions, reimbursements, and EDI troubleshooting for providers.
FWA Detection
Proactively monitor and identify fraud, waste, and abuse across payer transactions.
Provider Management
Coordinate provider contracting, onboarding, and ongoing network updates.
Physician Credentialing
Ensure credentialing compliance while reducing time to network participation.
Population Health Management
Enable outreach and wellness initiatives aligned with care and population health programs.
Compliance and Risk Management
Reinforce HIPAA, CMS, and regulatory compliance across payer operations.
AI Solutions That Optimize
Healthcare Payer Communications
and process efficiency across member and provider interactions.
100% call monitoring to support accuracy, compliance, and real-time coaching insights.
Automate member inquiries, claims status, and benefit questions across digital channels.
Improve clarity in member conversations through real-time voice optimization.
Provide on-call guidance, agent assistance, and proactive compliance alerts.
Why Choose Ameridial for Healthcare Payer Support
Ameridial delivers high-performance healthcare payer support designed to meet today’s requirements for accuracy, compliance, and elevated member and provider experience.
HIPAA-Compliant Infrastructure Across All Channels
Secure voice, email, SMS, and chat communications supported by certified systems and controls.
Trained Teams with Payer-Specific Expertise
Dedicated teams experienced in payer workflows, claims processes, and regulatory requirements.
Integrated AI for Quality and Efficiency
Improve accuracy, compliance, and productivity through AI-enabled quality and performance tools.
24/7/365 Multilingual Member & Provider Support
Serve diverse populations with responsive, empathetic assistance across channels and time zones.
Flexible, Scalable Delivery Models
Adapt staffing levels and service models to align with changing plan volumes and needs.
Performance Transparency and Custom Reporting
Access real-time visibility into KPIs, SLAs, call handling, and satisfaction metrics.
PCI DSS 4.0.1
ISO 27001:2022
HIPAA Compliant
SOC 2 Type II
MBE
Get in Touch Today
Ready to optimize your payer operations?
Connect with Ameridial to build smarter, scalable BPO solutions tailored for healthcare payers.
Frequently Asked Questions (FAQs)
Explore answers to common questions about Ameridial’s healthcare payer services and operational support capabilities.
What services does Ameridial provide for healthcare payers?
Ameridial supports healthcare payers with a comprehensive range of payer services, including enrollment assistance, member support, provider services, claims administration, credentialing, and compliance-driven operations. Our services are delivered through secure, regulated workflows that align with payer requirements.
Are Ameridial’s healthcare payer services HIPAA-compliant?
Yes. Ameridial delivers healthcare payer services through HIPAA-compliant systems, trained teams, and audited processes designed to protect member data and support regulatory compliance.
Can Ameridial support Medicare Advantage and Medicaid plans?
Ameridial supports Medicare Advantage, Medicaid, and managed Medicaid programs through enrollment support, member outreach, eligibility assistance, and ongoing plan operations.
How does AI improve healthcare payer service delivery?
Ameridial leverages AI-enabled tools to improve quality, efficiency, and compliance across payer operations, including call monitoring, agent assistance, and workflow optimization.
What differentiates Ameridial from other healthcare payer service providers?
Ameridial combines payer-specific expertise, compliance-focused delivery, multilingual support, and technology-enabled operations to help health plans scale services while maintaining accuracy, responsiveness, and member trust.
Healthcare Insights
& transform how you connect payers, providers, and patients.
Company
© 2026 Ameridial Inc. – the nation’s leading healthcare contact center. All Rights Reserved.