Improving Member Experience with a Health Insurance Call Center

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Improving Member Experience with a Health Insurance Call Center

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Client: Fortune 500 health benefits provider
Industry: Insurance, Healthcare
Service: Process re-design based on voice-of-the-customer (VOC) analysis, and Workforce Management

Challenge:

Fast growing insurer call center was receiving high level of member complaints and escalating operating costs.

Solutions:

Tracking the member experience from beginning to end helped the company identify specific process and policy changes that could improve the member experiences and lower costs. Actions taken included:

Projects to redesign, pilot, and implement simplified processes
Application of Guidon’s workforce management solution to improve associate utilization
Transparency and operating mechanisms between departments to managing the timing and content of mailings to members
Training and metric improvements

Results:

20% drop in call volume
Improved “first call resolution” rate (more member issues handled on first call)
16% drop in average handling time
Associate utilization rose from 70% to 80%
Cost savings/avoidance of nearly $1.9 million as the business grows

A call center for a large national health benefits company had been adding staff rapidly in response to their business growth and increased volume, which had reached about 2 million calls a year. Though the “throw bodies at it” approach was expedient, it ultimately created some problems, chief among them poor member and provider service along with excessive costs. To position the company better for continued growth, senior leadership asked Guidon to help them simplify their approach to servicing members and providers while bringing down operating expense.

Guidon’s first course of action was to dive deep into the call volume and company processes to understand what the member experience was truly like. This exploration took them beyond the boundaries of the call center to other departments. Once a picture was painted, some typical challenges to fast growth were exposed:

It was easy for callers (typically members, caregivers, or providers) to get handed off between departments with many callers not getting immediate answers, incorrect responses, or just lost in the shuffle.
Work schedules were numerous and complicated. There were many times when the center was either over-staffed or under-staffed.
Other problems in the call center were driven by actions taken by other departments. For example, though one factor in call volume variation was a seasonal spike associated with enrollment periods, other spikes were caused when departments such as Compliance or Marketing mailed out information that was unclear to members.

Guidon’s work helped the company identify and execute specific actions that would ensure they achieved the dual goals of an improved member experience and reduced cost. Several initiatives were launched to simplify processes. These initiatives helped establish inter-department transparency to coordinate and improve mail drops, and leveraged Guidon’s proprietary workforce management approach to match staff schedules to the call volume. Other changes included organization realignment and improved metrics and tracking. These actions led jointly by the business and Guidon drove the following gains:

A nearly 20% drop in call volume, due in part to having cooperation from other departments to develop clearer, simpler communications and to avoid the overlap of mailings from multiple departments.
A 16% drop in call handling time, which included time savings driven by a 50% drop in call transfers.
A 16% improvement in resource utilization.
Expense savings of approximately $1.9 million.

The company also recognized a shift in thinking by their own team – going from a functional focus to a “member experience” emphasis that opened the door for future projects and the beginning of a continuous improvement mindset.