Secret Shopping – See Your Plan Through the Member’s Eyes

Secret shopping is one of the most effective ways to understand how your plan performs in real-world scenarios. By posing as prospective members, these evaluations reveal whether your call center and sales teams deliver accurate, timely, and compliant information. CMS uses similar methods during Accuracy & Accessibility Studies, so proactive testing can help you avoid corrective actions and penalties.

Secret shopping goes beyond compliance—it uncovers gaps in training, system functionality, and customer experience that impact member satisfaction and Star Ratings. It evaluates critical factors such as call accessibility, IVR navigation, language services, and the accuracy of benefit explanations. These insights allow plans to address issues before they affect enrollment or trigger CMS scrutiny.

Why Secret Shop?

Secret shopping predicts how your plan will score during CMS evaluations and identifies gaps in training or processes before they become compliance issues. It improves member experience, strengthens operational readiness, and reduces audit risk. By simulating real-world interactions, plans gain actionable insights that drive both compliance and customer satisfaction.

BluePeak recommends that you stagger call timing across weekdays and weekends to capture a full picture of performance. In addition to staggering calls, you should test escalation paths by requesting supervisors and challenge agents with realistic scenarios to build call control skills. It is valuable to aggregate findings for trend analysis and make sure to address high-priority issues within 48 hours. Last but not least, engage leadership to secure resources for remediation and continuous improvement.