TRANSFORMING HEALTH PLAN OPERATIONS THROUGH INNOVATION AND INSIGHT

Strategic Solutions to Power Health Plan Performance

EstatePilotX delivers a comprehensive suite of health plan support services designed to streamline operations, optimize care delivery, and enhance the experience for both members and providers.

Our scalable, HIPAA-compliant solutions span the entire health plan lifecycle—from sales and quoting to core claims processing, medical management, customer service, and beyond. With decades of experience as a trusted Medicare BPO partner, EstatePilotX tailors each engagement to drive operational efficiency, compliance, and member satisfaction.

We offer end-to-end support across critical functions, including:

• Member onboarding and engagement

• Provider credentialing and data management

• Fraud, waste, and abuse detection

• Digital engagement and omnichannel support

By reducing administrative burden, improving process accuracy, and enabling smarter decision-making, EstatePilotX helps health plans, providers, and members achieve better outcomes—cost-effectively and at scale.

TAILORED SOLUTIONS THAT TRANSFORM HEALTH PLAN OPERATION

Lead Generation Services

Identify and target potential members to expand your health plan’s market share.

License Agent-based Outreach & Enrolment

Provide expert outreach and compliance-based Medicare enrollment services to drive member acquisition.

Annual Enrollment Programs

Manage open and annual enrollment periods, reduce member attrition, and maximize retention with targeted outreach and education as a reputed Medicare call center.

Customized Quoting Solutions

Deliver accurate, efficient, and personalized quoting services to streamline plan selection for prospective members, ensuring they choose plans aligned with their needs.

Account Setup, Enrollment, and Maintenance

Simplify member onboarding and ensure the accuracy of member data throughout the lifecycle.

Member Onboarding and Education

Offer personalized education to help members understand their benefits and health plan options during Annual Enrollment Period.

Premium Billing and Reconciliation

Manage premium invoicing, payment collection, and reconciliation for financial accuracy.

Preventive Care Outreach & Support

Promote health and wellness through annual wellness visits and preventive care reminders.

Benefit Management

Clarify and assist with benefit utilization to ensure members maximize their coverage.

Member Services Contact Center

Provide 24/7 support for members via multi-channel member support (phone, email, and chat).

SALES, QUOTING, AND UNDERWRITING

EstatePilotX helps health plans optimize sales, quoting, and underwriting processes with comprehensive, tailored support

MEMBER SERVICES

We enhance the member experience with a range of services designed to improve engagement, education, and satisfaction:

Provider Customer Service

Handle provider inquiries, claims issues, and network participation assistance.

Fraud, Waste, and Abuse (FWA) Detection

Identify and mitigate FWA risks to protect the integrity of the health plan’s network.

Support for Provider Claims and Billing

Address provider claims inquiries and assist with billing challenges to ensure timely reimbursements.

Provider/Facility Profiling

Maintain accurate and comprehensive profiles for healthcare providers and facilities.

Provider Education and Training

Offer comprehensive education and training programs to keep providers informed about policy updates, compliance requirements, and best practices for interacting with the health plan.

Provider/Facility Data Management

Ensure accurate and up-to-date information for providers and facilities within the network.

Physician Credentialing

Ensure proper documentation and compliance for physician enrollment in the network.

PROVIDER SERVICES

EstatePilotX provider services ensure smooth operations and strong provider relationships:

Credentialing and Network Participation

Streamline the credentialing process, ensuring compliance with regulatory and network guidelines.

Care Management

Handle provider inquiries, claims issues, and network participation assistance.

Utilization Management

Ensure appropriate use of healthcare services, improving care quality and reducing unnecessary costs.

Wellness Management

Deliver health promotion and disease prevention programs to improve long-term member health.

MEDICAL MANAGEMENT

EstatePilotX medical management services are designed to improve care quality and reduce costs:

Claims Adjudication

Ensure claims are reviewed, processed, and paid accurately according to plan guidelines.

Claims Re-Pricing

Re-price claims based on provider agreements to ensure fair and timely reimbursements.

CORE CLAIMS PROCESSING

EstatePilotX streamlines the claims processing lifecycle, ensuring accuracy and timely reimbursements:

Claims Adjustments

Facilitate adjustments to claims, ensuring accurate settlements for both members and providers.

Payment Reconciliation

Reconcile payments to ensure consistency between claims, payments, and provider agreements, focusing on member and provider experience.

HCC Coding and Reporting Support

Provide HCC coding support to ensure accurate risk adjustment and compliance with healthcare reporting standards.

Resolving Payment Disputes

Address payment discrepancies and disputes between health plans, members, and providers.