Open enrollment. It's a months-long marathon that industry veterans call "the Super Bowl of healthcare"—a high-stakes period where everything in technology and operations gets pushed to the limit.
75% of membership renews during this time, creating massive volume spikes that can make or break a payer's entire year. Unlike other industries that spread workloads throughout the year, healthcare payers face an unforgiving concentration of activity that demands flawless execution across people, processes, and technology.
We spoke with four enrollment veterans at enGen and Highmark, Inc. to understand the industry’s biggest challenges and the tactics they employ to overcome them.
In the below article, you’ll hear from:
Data issues turn small errors into million-dollar problems
Enrollment data quality is everything. Industry studies show 8-12% error rates in enrollment submissions, with each error costing an average of $172 to resolve. When multiplied across millions of members, these seemingly small data problems create massive operational and financial headaches that can reach ~$25 billion annually across the industry.
The root issue starts with inadequate systems and processes. Many employers rely on manual processes and HR systems that weren't designed for complex healthcare enrollment decisions.
Data flows through multiple parties—brokers, clearinghouses, and vendors—each with their own interpretation of data standards. By the time enrollment information reaches payers, it's often incomplete, inaccurate, or formatted inconsistently.
Poor data quality doesn't just create operational friction. It directly impacts member experience and regulatory compliance. Members can't access care when their information is wrong, pharmacies reject prescriptions due to eligibility errors, and payers face potential penalties for coverage gaps.
How the pros fix it
The most successful payers have moved beyond reactive data cleanup to proactive quality management systems that identify and fix problems before they cascade through operations. The key is implementing systematic approaches that address data quality at its source and using automation as much as possible.
Peggy Bruck's AI-driven data framework
Peggy Bruck, Director of Product and Technology at enGen, has developed a comprehensive approach to keep enrollment data as clean and valuable as possible.
"Enrollment data either makes or breaks the entire process. Traditionally, it’s a painstaking process that requires a lot of manual effort.”
Upfront visibility into data problems before they cascade through the system is the goal. Here’s how Peggy and her team keep the data standards high.
• Score data across three dimensions: Accuracy (data is correct), validity (data meets field requirements), and completeness (all required fields are present)
• Surface errors before processing: Identify all data problems upfront rather than discovering them during processing or in providing the contracted service (beyond enrollment processing)
• Use AI for automated data fixes: Deploy artificial intelligence to automatically correct data that can be reliably fixed without human intervention
• Standardize data interpretation: Create consistent rules for how enrollment data should be formatted and interpreted across different sources
enGen’s enrollment AI solution, currently in refinement, goes beyond identification to active remediation: "We're using AI to score, fix, and manage data automatically, and we’ve included our framework principles within it. Without it, we would have to remediate around 1,000 errors a day."
"Enrollment data either makes or breaks the entire process. Traditionally, it’s a painstaking process that requires a lot of manual effort.”
-Peggy Bruck, Director of Product and Technology, enGen
Volume spikes and staffing equations
The seasonal spike—typically a three-month period—creates impossible staffing equations. Payers need three to four times their normal workforce during peak periods, but can't afford to maintain that headcount year-round. Traditional hiring cycles take months, making it difficult to scale up quickly.
Meanwhile, the consequences of inadequate capacity are severe: long wait times, delayed processing, member complaints,. Ultimately, payers are forced to choose between expensive overtime, temporary staffing, or service degradation.
How the pros fix it
Leading payers have developed sophisticated workforce planning strategies that combine predictive analytics, service segmentation, and flexible resource allocation to manage extreme volume fluctuations without compromising service quality.
Sean Bellus's strategic workforce planning
Sean Bellus, Senior Vice President of Health Plan Operations at Highmark Inc, manages the workforce planning puzzle by understanding both volume patterns and employee behavior. His approach treats hiring timing as a precise science rather than guesswork.
"About 75% of our membership renews on January 1st. You get about 10% in July which is like the mini peak. And then another 15% is spread out the rest of the year," he explains. "We tend not to hire classes around the slower months of February, March, or April.”
• Map exact volume patterns: Use historical data showing when 75% of volume hits (around January 1st) to predict precise staffing needs months in advance
• Plan for natural turnover: Build hiring schedules around the reality that contact center workers typically leave during low-activity periods rather than waiting for busy seasons
Develop rapid resource mobilization protocols: Establish cross-departmental agreements to reserve help (about 100+ people) during unexpected volume spike.
"About 75% of our membership renews on January 1st. You get about 10% in July which is like the mini peak. And then another 15% is spread out the rest of the year.”
-Sean Bellus, SVP, Health Plan Operations, Highmark Inc.
David Palmer's data-driven call routing
David Palmer, Vice President of Member Experience, Health Plan Operations at Highmark Inc., takes a granular approach to volume management through sophisticated call segmentation. "New benefit products or wide-sweeping changes to policies lead to more call volume.” Here’s how Palmer handles the dynamic nature of benefits:
• Categorize memberships into four complexity tiers: Normal renewals, plan discontinuations, major benefit changes, and complex specialized situations
• Route each tier to specially trained agents: Create separate phone skills and Interactive Voice Responses (IVR) so members reach agents trained for their specific situation
• Train new hires exclusively on high-volume, low-complexity calls: Use inexperienced staff for routine inquiries while reserving seasoned agents for complex problems
• Use ambient listening technology to analyze call patterns: Track historical data on which benefit changes drive which types of calls to predict future volume by category
Palmer emphasizes the importance of detailed preparation: "We treat enrollment like an enterprise-wide initiative...it's time sensitive and we look at it from a people-process-technology perspective."
"We treat enrollment like an enterprise-wide initiative...it's time sensitive and we look at it from a people-process-technology perspective.”
-Dave Palmer, VP, Member Experience, Health Plan Operations, Highmark Inc.
Crisis response under regulatory and member pressure
When things go wrong during open enrollment, they go wrong fast and publicly. Members need immediate access to care, regulators demand compliance, and any failure becomes a public relations fiasco.
Research shows 58% of insured adults experienced problems with their health insurance in the past year, highlighting how quickly operational issues translate into member dissatisfaction. Payers need rapid response capabilities that can mobilize resources within hours.
How the pros fix it
The most effective payers combine executive oversight, flexible staffing arrangements, and real-time performance monitoring.
Jennifer Tulios approach to system stability
Jennifer Tullio, Vice President of Platform & Service Management at enGen has institutionalized crisis preparedness through a few ways, but the leading mainstay is structured executive oversight during peak periods. “Before open enrollment begins, we set up reoccurring meetings with C-level executives and various leaders."
But that’s not the only tactic. Here’s how Tullio prepares for the unexpected:
• Monitor critical success metrics closely: Track portal uptime, ID card production timelines, and billing accuracy as key indicators of successful open enrollment
• Implement blackout periods for non-essential changes: Only approve emergency changes during November-December, no infrastructure changes or new functionality unless it directly impacts open enrollment
• Run automated monitoring scripts: Use behind-the-scenes scripts and checks to ensure systems are running smoothly and catch issues immediately
• Be patient: Don't declare victory until February-March after confirming no pharmacy issues, claims payment problems, or member access disruptions
David Palmer's team resilience strategies
During peak enrollment, a single agent at a call center can take anywhere from 50 to 100 calls a day. Palmer recognizes that crisis management isn't just about systems and processes—it's about maintaining human performance under extreme pressure. "We celebrate the small wins. They boost morale but they also help us zoom in on winning tactics.”
• Hold daily huddles during peak periods: Start each day acknowledging the previous day's accomplishments and setting realistic expectations
• Enable flexible work schedules: Let people start at 5 AM or other preferred times to manage their energy and provide better coverage
• Acknowledge incremental progress: Celebrate moving from "underwater" performance to “manageable.” Don’t let “perfect” get in the way of “good.”
"We celebrate the small wins. They boost morale but they also help us zoom in on winning tactics.”
-Dave Palmer, VP, Member Experience, Health Plan Operations, Highmark Inc.
From annual crisis to competitive advantage
The most successful payers understand that open enrollment success requires year-round preparation. Enrollment winners invest in data quality foundations, build resilient systems, train their teams, and develop powerful crisis management capabilities.
"It's where everything that you do all year comes together," Bellus reflects. "It’s also one of the biggest priorities for the entire organization which brings almost everyone together. People are eager to partner up and be as successful as possible."
Success during this peak performance period requires more than just showing up—it demands the kind of preparation, precision, and teamwork that turns an annual challenge into an innovation engine.