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Is your Call Center the Canary in the Coalmine?

September 17, 2013

You can always tell the kid who’s new to a sport and needs a lot of initial coaching and TLC.  Starting in a few weeks, a whole new group of players will enter the insurance game, and they won’t be the already well trained Benefits Depts of companies or their long-time insured employees.  They’ll be insurance newbies, their questions will be harder to answer within existing Call Center SLAs, and inbound call volumes will go up by multiples for the next few years.  Many won’t be able to go to your self-service site to get answers since they won’t even know how to verbalize the many questions they need, and deserve, answered.  But like talented amateur athletes anywhere, give them a year to master technique and demand even more detailed answers. Your Call Center is about to change and bear the brunt of health insurance becoming a contact sport, and the customer experience will suddenly be measured in 1.5 minute call durations, not years.

Thus, your low paying necessary customer support evil will become the face of your company and, most likely, the second most crucial component in retention after claims payment. Having long mastered the B2B purchasing and service game with annual contracts between companies, L&H carriers will now have to face annual reselling tens or even hundreds of thousands of new customers. As these consumers have learned with their cell phone contracts, changing annually in a highly competitive market of dueling providers is the desired situation.  Basically, in the Health insurance market, everything has changed with the click of the President’s ballpoint pen.  Every Call Center interaction will be a positive or negative x-Ray of your company’s value proposition and customer experience, not to be measured under the typical First Time Resolution and Wait Time metrics.

Many Call Centers remain a prisoner of their technology, no matter how recently updated or replaced.  For every improved IVR and chat capability, there currently exists a hard limit to the training and functionality a CSR can bring to the caller, making that interaction frustrating if it’s for anything more than clarification.  As we’ve written before, customer support has evolved to multiple channels, where customers now try self-service first, then use chat, and as a last resort call if they remain unsatisfied. Therefore, most inbound callers will be pre-frustrated, not patiently waiting to hear a canned answer being read from a knowledge base.  They will require solutions. Clearly, the best way is to reduce inbound calls in the first place.

Best Practice for Call Centers is to develop a Journey Map, aligned with data sources, CSR entitlements and a range of allowed transactions. Script out the flow within the support organization, rather than make cold hand-offs between support functions, especially during escalations. But even Better Practice is to recognize the Journey Map crosses multiple silos and has to include an end to end view of a customer cycle, from initial underwriting to billing to claims and renewal.  Claims remain the biggest source of dissatisfaction for insureds, and for the newly insured, your Call Center will have to coach them on coverages, deductibles and patient responsibilities.  Claims in particular have several complicating factors affecting customer retention:

  • The amount covered largely depends on how the Provider codes the charge
  • Patient Responsibility and deductibles paid at the time of treatment hits the insured right where it genuinely hurts while it genuinely hurts
  • The claims mobile application or portal users will almost always not understand your content accurately, being agitated or feeling financially threatened.  Then they’ll call.
  • Multi-language support will be required – some Call Centers are bracing for 100+ languages, and how will your mobile claims app deal with this population?

Therefore, L&H carriers must re-engineer their customer facing claims applications and screens, so all insureds clearly understand how they were charged and how you paid the claim, answering their questions upfront.  We had a situation with a Digital Wallet portal for a Health carrier where when we consumer tested what the digital agency told us were great screens (we had our doubts, but what did we know, we weren’t wearing fedoras and arrived on time for meetings), the feedback was almost entirely “very confusing”, and “not sure what it’s telling me or what I should do next”.  We had webcams monitoring their facial expressions and fear, confusion and anger were not uncommon looks. After some back and forth difficult conversations, the digital agency redesigned the screens to allow for the agitated user. Retesting showed the revised screens achieved higher self-service customer support closure rates, thus reducing potential Call Center volumes by several percent.

A large part of preparation is also allocating time and money to end to end quality and reliability checks for the entire backbone – network connections, data feeds, transaction processing time and stability, phone lines, etc., and most importantly, ensuring the IVR menu is sufficiently straightforward for a newly insured person to make the right choice (thereby avoiding hand-offs and call backs).  The goal is to ensure low rates for Call Blockage and Abandonment.  How much money should be allocated to end to end testing (including dialing in as if you were a caller)?  On a new implementation, our experience is in the range of 10% of the project budget.

Another factor is training and CSR scheduling. Always a tough job, being a CSR to newly insureds will be draining for the next few years, with frequent breaks and group training and venting sessions essential for preventing burnout and turnover.  CSR job descriptions will have to change from Phone Demon to Counselor and Sales Rep, with concomitant changes in earnings and career path. Hiring decisions will have to include attitude and flexibility, as well as grace under pressure. SLAs will grow from down and dirty operational First Call Resolutions and volumes metrics, to adding value proposition reinforcement and customer satisfaction targets.

Cost takeout, or at least cost stabilization, will be the go-forward mandate given the 80% Medical Expense requirement and a sure way to do this is to reverse solve inbound call sources – start with the Journey Map, fix anything which could lead to a call, and rethink your Call Centers as the portal to the end to end Organization.

How big a game will this be?  108M Americans watched Super Bowl XLVII, this year, but that involved only about 118 players – factor in 48M uninsured and the Kaiser Family Foundation, in March 2013, concluding 57% of Americans didn’t understand how they’d be impacted by the Affordable Care Act, and the potential call-in volume is immense. Then, add-in Company Private Exchanges and Retirees from major companies being moved to Exchanges, and the game day pressure on Call Centers is only going to increase for the next few years.  Are you ready?

Richard Eichen is the Founder and Managing Principal of Return on Efficiency, LLC, , focusing on companies, initiatives and products where technology is the primary means of delivery and revenue. He is one of their senior Turnaround, Transformation, Program Rescue and Process Rescue leaders.  As a Change Agent, Trusted Advisor, Program Leader and Interim Executive, Rich has over 25 years hands-on experience reshaping companies, Operations, IT/Systems Integration and strategic initiatives.  He can be reached at, and followed on Twitter, @RDEgrowroe.


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