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Great Health Insurers Need Great Customer Service Options

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What You Need to Know

  • About half of health plan enrollees think of the call center as the primary plan communication channel.
  • For the enrollee, improving customer experience means improving the call center.
  • Well-designed digital self-service tools may help, by reducing the load on the call center.

Navigating a health crisis is an incredibly emotional experience — a truth the pandemic has brought home to millions of people. It’s no surprise, then, that those looking to communicate with their health plans want to know they can still talk to a real, empathetic, and insightful human being on the other end of the line.

That’s one of the main takeaways from a new survey of 3,000 health plan members. Despite widespread advances in digital health technologies, nearly half told us they still prefer the call center as their primary health plan communication channel. Furthermore, three of the four top responses about what members felt would improve engagement with their plans involved call center experiences, including shorter hold times, customer service reps (CSRs) with relevant information, and personalized recommendations.

When you, the agent or broker, get complaints about the health plans, many of those complaints may begin with stories about long periods spent on hold.

Unfortunately, new and rapidly evolving challenges make delivering successful call center experiences difficult just when the plans’ members need them the most. A historic labor shortage has made it harder to recruit and retain workers in a profession already rife with turnover (up to 45% across all industries). The shift to remote work environments has revealed shortcomings in customer experience technology and workflows. And an increase in outsourcing threatens to exacerbate existing legacy system inefficiencies and process disconnects.

So how can the health insurers you work with efficiently and effectively meet the demand for better call center experiences? The key is understanding that these experiences must go hand-in-hand with digital self-service options. Rather than replacing call centers, these digital options can relieve some of the pressure placed on them, reducing long hold times and creating more time for CSRs to connect with members facing stressful health and financial challenges.

Digital Self-Service and the Call Center

The pandemic accelerated a mass adoption of health tech by consumers, providers, and payers alike. But health plans need to recognize that investment in new technologies doesn’t mean leaving the human aspect of call centers by the wayside.

For instance, new data suggests that nearly 80% of US contact centers plan to deploy artificial intelligence (AI) in the next three years. But on its own, today’s AI can’t replace a real person or accurately analyze the complexities of human emotion. Case in point: We all know how far a shared laugh can go to ease stress. A recent report shows that AI just can’t compete with actual CSRs in this type of meaningful human connection.

What our survey suggests is that investments in digital self-service options need to work in tandem with the call center. After all, members told us they prefer the former channel nearly as much as the latter.

In an effective model, payers would deploy digital self-service to help members accomplish routine tasks and access information (e.g., checking on a claim status, scheduling an appointment, requesting a new ID card), thereby freeing up CSRs to better provide personalized recommendations and empathy for those in need.

At the same time, those CSRs should have adequate training and easy-to-access profile data to ensure they can provide timely, thoughtful, and personally-relevant insights to their members. That requires addressing siloed technology systems, which often leave CSRs feeling disconnected from the rest of the company and can force them to log into multiple different systems to find the full set of member information they need. These legacy systems can also inhibit visibility across departments — meaning CSRs may not be able to see a recent marketing campaign or the status of a previous inquiry — leaving them unable to proactively engage members in positive ways.

Health plans that can ensure a seamless, coordinated, and personalized experience across both channels will ultimately improve member satisfaction and operational efficiency. For instance, research shows about $8 in avoided costs per call when members leverage digital self-service for basic tasks like finding a provider, managing enrollment in health programs, and downloading ID cards. To put that in perspective, a payer fielding 250,000 calls each year can realize over $2M in savings by implementing successful digital self-service functions. Relieving pressure on CSRs and providing them with better training and access to information can also reduce onboarding expenditures, as hiring and training new frontline staff can cost $15,000 per employee.

If the late 2021 and early 2022 surge in cases is any indication, the pandemic won’t be subsiding anytime soon. This means that now is the time for health plans you work with to heed the lessons learned in the past two years and improve their call centers — with the help of digital self-service options.


Jyoti Mokal is vice president for product engineering at Zipari.

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(Photo: bbernard/Shutterstock)