In healthcare, every call is a compliance record. And a missed enrollment.
Member services, claims, and Medicare enrollment each carry HIPAA, CMS marketing rules, and revenue in the same conversation. QEval scores every call for disclosure, eligibility handling, and the enrollment moments a 2 percent sample never sees.
What a healthcare call actually carries.
Member services, claims, and Medicare enrollment each carry a compliance record, a member-experience moment, and revenue in the same conversation. A 2 percent sample sees almost none of it.
You cannot sample for CMS or HIPAA
The enrollment call nobody reviewed is the one that becomes a finding. When an auditor asks whether a disclosure was given, a hand-reviewed sample is not an answer.
Disclosures and eligibility scripts drift
Scope of appointment, recorded-line notice, and eligibility questions slip on busy days and across sites. You find out in an audit, not in time to fix it.
Revenue walks out on missed pitches
Eligible members never offered the ancillary coverage they qualify for. The moment was on the call, and a sample never saw it.
Short calls hide low effort
Agents giving up early on a complex enrollment. Without scoring every call, the pattern stays invisible until the season is over.
What QEval hears on a single enrollment call.
One routine Medicare enrollment call. Tap a flag to see exactly where on the call it happened. This is the difference between a 2 percent sample and 100 percent coverage.
Thanks for calling, this is Dana. Are you looking to enroll in a Medicare Advantage plan today?
Yes, I think so. I just turned 65 last month.
Great, let me grab a few details and get you signed up.
I take a couple of medications. Will those be covered?
Most are. I can put you on the basic plan, that is the easiest.
Okay, you are all set with the basic plan.
Alright, thank you.
Confirm scope and eligibility before enrolling, verify the formulary against the member's medications, and offer the ancillary coverage the member qualifies for.
The same calls, finally read in full.
CMS and HIPAA disclosures on every call
Scope of appointment, recorded-line notice, and required disclosures are checked across 100 percent of calls at 95%+ recall, with the transcript moment attached as evidence.
Compliance and redaction →Member confusion and complaint risk
Eligibility questions, confusion, and complaint signals are scored on every call and surfaced before they become a grievance or a disenrollment.
Customer intelligence →The enrollment and the ancillary you are missing
Missed pitches and ancillary opportunities are surfaced on every call.One payer found $1.65M in missed pitches and $1.98M in missed ancillary, contributing to $5.3M in total added revenue for the season.
Revenue intelligence →Where handle time and capacity go
Handle-time and call-driver patterns are clustered automatically. The payer reduced average handle time by a minute and improved capacity 23 percent.
Auto QA →Coaching tied to the enrollment moment
Low-effort short calls and missed disclosures are coached to the second they happened. The payer found real agent effort on only 6 percent of short calls.
Coaching and performance →PHI never leaves to an outside model
Protected health information is redacted before any model runs, and the Mixture-of-Experts model is built and run in-house. Nothing trains a third-party AI.
Security and trust →A national healthcare insurance provider ran QEval across 240,235 Medicare enrollment calls, scoring 100 percent of them instead of a sample. QEval found $1.65M in missed pitches and $1.98M in missed ancillary enrollment, and showed that agents put in real effort on only 6 percent of short calls.
Acting on what QEval surfaced, the payer increased conversion 27 percent, reduced average handle time by a minute, and improved contact-center capacity 23 percent on the same headcount. The documented result was $5.3M in additional revenue in a single enrollment season. The outcome is attributed to the organization, anonymized at its request.
What QEval helps you evidence.
QEval documents adherence across every interaction. It surfaces and records; it is the evidence layer your compliance team uses, not a substitute for legal counsel.
Protected health information redacted at ingest via Named Entity Recognition, before any model runs, and never sent to a third-party training loop.
Scope of appointment, plan-suitability language, and required Medicare Advantage disclosures checked on 100% of enrollment calls.
Recorded-line notice and consent language flagged when missing, across every call rather than a sample.
Special-enrollment and eligibility questions monitored for accurate, complete handling, with the moment attached as evidence.
Misleading or high-pressure language scored, so suitability and fair-treatment risk surface before a complaint does.
Complaint and grievance signals detected and routed in real time, with a full audit trail from score to the words that triggered it.
QEval surfaces, scores, and documents adherence to your policies and applicable regulations. It does not provide legal advice, and the items named here are illustrative of what QEval helps you monitor, not a complete compliance checklist.
Healthcare leans on compliance, revenue, and operational intelligence.
Quality and compliance is the floor. The value compounds in member experience, enrollment revenue, and the capacity drivers, all read from the same calls.
Questions compliance and enrollment ask.
Can we evidence HIPAA and CMS disclosures for an audit?
Yes. 94%+ classification accuracy is a contractual SLA, required disclosures are checked on 100% of calls, and every score carries an audit trail back to the transcript moment. PHI is redacted at ingest before any model runs.
Where does protected health information go?
Nowhere outside QEval. PHI is redacted at ingest through Named Entity Recognition, before any model runs, and the Mixture-of-Experts model is built and operated in-house. Your data never enters a third-party foundation model's training loop.
We already have QA from our CCaaS. Why add QEval?
CCaaS-native QA typically scores a small sample at 65 to 70% accuracy. QEval scores 100% of calls at the 94%+ contractual SLA and reads beyond compliance into enrollment revenue and capacity, where most of the value sits.
How fast can this be live?
30-day deployment, contractual. The payer above added $5.3M in a single enrollment season, and the documented customer-average is ROI in 120 days, with 60-day exit rights.
Bring us a season of your enrollment calls.
We will score a real sample of your enrollment, member-services, and claims calls and show you the disclosures, the missed enrollments, and the capacity your current program is not catching.