Every Member. Every Interaction.
Member services runs in one of the most regulated, highest-stakes environments in the economy. Yet most teams see less than 3% of their interactions. Scala gives leaderscomplete visibility across every member conversation, system, and workflow, with the intelligence to act on what they find.
Built for Member Services
Benefits confusion, claims status, open enrollment surges. Most platforms added AI as a feature. Scala was built for the work health plans face every day.
Root cause clarity
Connect conversations with claims, eligibility, and CRM data to understand why members keep calling back.
every language covered
Evaluate 100% of member interactions across channels and languages with a single QA framework.
Root Causes, Not Symptoms
Members call when they need help: finding an in-network doctor, understanding benefits, checking claims, resolving prior authorization, or getting pharmacy answers. Scala connects those conversations to the systems behind them, identifies what’s creating repeat contact, and directs the right fix across people, automation, and process. Built for health plans across every line of business, from Medicare and Medicaid to ACA and commercial.
100%
of member interactions seen, scored, and explained across human and AI agents.
20-30%
of repeat and avoidable contact identified by root cause, not buried in dashboards and sampled reviews.
unified intelligence
connecting conversations, workflows, systems, and teams, so health plans can see, understand, and act.
From Insight to Action
Insight only matters if it leads to action. Scala helps health plans deploy conversational AI agents across the channels members already use to resolve benefits questions, claims status, and scheduling, while internal agents handle the work that slows teams down, from notes and summaries to wrap-up tasks and next steps. Every agent runs inside guardrails your compliance team defines, so automation behaves the way your business expects.
Compliance by Design
PHI and PII demand more than a security page. Scala operates under SOC 2 Type 2 and HIPAA, with strict data boundaries and controlled, policy-driven integrations intoyour systems of record. Every interaction is captured with full context and reasoning, so your compliance team gets a complete audit trail, not a blackbox.
100%
of interactions captured with an auditable decision trail.
soc 2 type 2
audited controls, with HIPAA alignment.
Results in Weeks
Leaders see movement fast: QA coverage goes from a 3% sample to every interaction, repeat contact drops as root causes get fixed or automated, and the issues that drive grievances, CAHPS scores, and Star ratings surface before they compound. Because Scala is AI-native and embeds in the systems you already run, ROI lands in weeks, not quarters. Nothing to rip out.
Supercharge your teams and move operations forward.
Fewer surprises. Confident decisions. Real progress on experience and cost.
Book a demo and we'll show you how Scala turns complexity into clarity for teams like yours.