Problem
With more than 600,000 members, one of the nation’s largest government-funded health plan providers
faced a customer service challenge. Membership growth was stretching resources, and operating costs were
increasing, while eciencies were decreasing. The company needed a solution to enhance its customer service
program, consisting of inbound/outbound blended support and both dedicated and shared multilingual agents.
The solution also had to provide standardization, streamlined processes, reduced costs, increased scalability and HIPAA compliance.
Search for a Solution
The health plan provider was quickly outgrowing the technology services provided by another vendor. In order to meet reporting requirements and reach growth goals, the health plan provider needed enhanced functionality such as real-time reporting, web-based recordings, script customization and more. Ansafone‘s robust technology oering lled all of these requirements. What’s more, Ansafone’s Accessing Care Management technology mirrored the company’s internal operations to serve as a seamless extension of the health plan provider’s customer care program.
Solution
Ansafone tailored its proprietary call center management process to provide a comprehensive
customer care methodology. Through these strategies, Ansafone:
- Took calls for Access to Care membership inquiries
- Managed call escalation of grievances
- Expedited appeals
- Documented key aspects of call interactions
- Met all service level requirements
- Provided confidentiality and HIPAA compliance
- Managed disaster recovery/redundancy efforts
Ansafone utilized a shared agent model that was especially eective for the multilingual aspect of the customer care program, allowing for greater exibility to support a diverse membership base while decreasing xed costs for dedicated agents.
The Ansafone solutions’ outbound components included managing numerous membership outreach strategies such as: welcome calls, member¬ship retention, enrollment/eligibility campaigns, and Healthcare Eectiveness Data and Information Set (HEDIS) preventive care.
Finally, by providing quality people, Ansafone helped reduce talk time, hold time and after-call work, all of which resulted in lower average handle times. This KPI not only saves money directly, but is also connected to improved customer experience.
Results & Benefits
Ansafone met the health plan provider’s volume and quality goals within the rst 3 months
of the program, far exceeding estimates.
Results included:
- An average savings of more than 86 percent per call for the after-hours/ weekend calls
through the shared agent model component of the program. - An 18 percent increase in member retention rates through promptly and proactively
generating pertinent information and responses for customers to create high customer satisfaction. - Positive impact on HEDIS score through implementation of focused campaigns to aid members
in gaining access to care.
Overall, Ansafone implemented solutions that deliver greater eciencies, provided higher
quality customer experience and increase member satisfaction.
