Using Appeals and Grievance Data to Improve
Member Satisfaction

  • November 25, 2020
  • 2:00 PM – 3:00 PM ET
  • Online

As health insurance providers prioritize the goal of bringing the voice of the consumer to the forefront of their decision-making process, the analysis of CMS’s Complaint Tracking Module (CTM) appeals and grievance data is critical in understanding what changes must be made to enhance enrollee satisfaction. By understanding the issues and events that result in a negative member experience, and by making the commitment to take swift action to address and correct the root cause of the abrasion, organizations can repair the relationship, which translates into consumer loyalty, growth and member retention.

In this webinar, we will discuss how analysis of CTM Appeal and Grievance Data can contribute to the implementation of positive changes that improve the member experience. We will discuss how analysis of internal appeal reversal rate and grievance trends can be used to identify opportunities to enhance the member experience and delight customers. Health Insurance Providers possess a gold-mine of information in their own tool-box, with CTM and Appeals & Grievance (A&G) data.

Attendees will learn about:

  • Data elements to capture in order to identify sources of abrasion
  • The impact of internal appeal reversal rate
  • How to use PDSA (Plan-Do-Study-Act) methodology to implement process improvements


Laurie Delgado
Vice President of Appeals & Grievances
Beacon Healthcare Systems

Laurie serves as the Vice President of Appeals & Grievances at Beacon Healthcare Systems. With more than 20 years of experience overseeing Medicare appeals and grievances for two of the nation’s largest and most highly respected health plans, she currently provides oversight of the company’s highly acclaimed Virtual Appeals Manager (VAM), the industry’s most intuitive and easy-to-use appeal and grievance tool.