Overview:

Process Redesign for the customer service unit in a Medicare Advantage division of a Large, East Coast Healthcare Payer

Business Issue:

The Medicare Advantage division, an East Coast Blue, was faced with inconsistent delivery of customer service, increasing customer complaints, and a First Call Resolution that did not meet the Blue Cross Association standards. There were no clear expectations or processes for how calls should be handled, and the overwhelming number of tools and reference documents available to customer service representatives went largely unused. The organization engaged us to conduct a strategic assessment of the operation and implement the required changes.

Actions:

• Evaluated the customer service operation, including a comprehensive review of the call handling, organizational structure, call metrics, staffing model, training approach, technology, call scorecards, and reference tools
• Developed a detailed set of call handling expectations, which outlined the step-by-step call handling process for 29 different call types representing over 90% of the total call volume
• Redefined the call escalation criteria and processes to improve First Call Resolution, reduce complaints and ensure that the Level 2 customer service team was handling the more complex, sensitive call types
• Evaluated over 2000 reference documents and tools available to Customer Service Representatives (CSRs), and identified the 60 that support over 90% of customer questions
• Implemented new call handling documentation in an online, searchable format with hyperlinks to provide 1-click access to any required tool or reference document
• Developed a detailed, seasonally-adjusted staffing model to project staffing levels for BCBS SC and their 3rd party vendor, reducing staffing costs while delivering desired levels of service
• Partnered with the client’s internal training team to design and deliver training to implement the new processes and documentation

Results:

• Enabled the client to provide consistent delivery of accurate information to its members
• Redesigned and simplified the call scorecard with specific measurement and acceptance criteria
• Increased First Call Resolution rates by 10% within 3 months of implementation