Many health plans still treat complaints, appeals, and grievances (CAG) as back-office administration. Capture the case. Check the box. Close the file. But that’s far from enough. A single delay can now spiral into audit flags, penalties, member churn, and STAR rating drop. “In 2025 alone, penalties ranged from $5,800 to over $2 million per violation.”
For many plans, that wasn’t just a fine, it was a wake-up call. A call to move away from manual routing, legacy systems, and templated responses that were never built for today’s regulatory pressure or tomorrow’s member expectations.
Complaints Don’t Wait. Why Should You?
The health plans making the leap aren’t guessing. They’re already automating intake, slashing manual review times, and leveraging AI to flag compliance risks before they translate into penalties. Some have even shaved weeks off resolution times and lifted their STAR Ratings in the process. This eBook breaks down exactly how they’re doing it.
Download this eBook to uncover where health plans are getting stuck, what’s changing in the regulatory and member landscape, and how leaders are re-designing their approach.
Here’s what you’ll learn:
- The six hidden friction points damaging CAG processes and how leading plans are eliminating them
- How AI and low-code automation can unlock compliance, personalization, and audit readiness
- What forward-thinking plans are leveraging to lift STAR ratings, reduce costs, and win trust
