State Based Exchange Contact Center

Contact Center and provide the technology, workforce, operational services, and ongoing support necessary to deliver Exchange customer assistance services.
- Contact Center will provide frontline consumer assistance as well as specialized and more complex operational support and issue resolution. The service model will support appropriate routing of inquiries, cases, and work items to personnel with the skills, training, system access, and authority necessary to address the applicable issues.
- Contact Center will operate within a multi-vendor Exchange environment and will integrate or interoperate, as appropriate, with the Exchange technology platform and other State-operated or third-party systems
- Contact Center services are anticipated to include support for:
• General Marketplace information and consumer education.
• Consumer account and application assistance.
• Assistance navigating Exchange processes and functionality.
• State-approved consumer identity verification and authentication processes.
• Qualifying Life Event (QLE), Special Enrollment Period (SEP), Data Matching Issue (DMI), and other verification-related support, including review and verification of consumer-submitted documentation in accordance with OID-established policies and procedures.
• Enrollment-related questions and issue resolution.
• Case intake, tracking, prioritization, escalation, and resolution coordination.
• Complaint intake and escalation.
• Appeals intake and administrative coordination.
• Reinstatement and other operational requests within State-approved processes.
• Complex issue troubleshooting and follow-up.
• State-approved outbound consumer contact, including callbacks and operational follow-up, as applicable.
• Identification and escalation of suspected fraud, abuse, identity concerns, or other potentially improper activity in accordance with OID-established processes.
• Support for other Marketplace stakeholders as defined by OID.
- Contact Center will support inbound mail and document processing activities associated with Exchange consumer support and operations. The Supplier will provide the operational capabilities necessary to receive, process, track, and route inbound physical mail and documents, as well as documents received through other State-approved intake channels