Call Center Overview

Our call center provides quality customer service with an emphasis on helping members become well informed while unilaterally focusing on providing accurate and helpful data to clients and providers.

The way we achieve this goal is by having detailed and thorough training, focusing on quality initiatives and managing the staffing and workload proactively.

The call center has a dedicated trainer who is focused on creating training documentation, training new representatives, training new clients on applications that they utilize, and working with the quality team to recognize trends for corrective or follow up training.

Call Center

The trainer is involved from the very beginning of an implementation, which enables them to provide complete and accurate training material. The trainer is an expert on effective training practices and all of the applications used by the team.

The focus on exceeding service levels is evident by the results achieved by the call center. The average quality measure achieved by the team over the last year was 95% accuracy, the average abandonment rate for incoming calls was under 2%, and the average speed to answer was under 15 seconds while handling over 20,000 calls per month. The management staff makes immediate moves within the queues based on reports and the dashboard, which is monitored real time via monitors that are visible by the team and on management’s desktop. Representatives tasked with making outbound calls are provided with production goals related to outbound call volume, average handle time, and time spent on documentation.

Call Center Services

The call center specializes in performing multiple roles, all directed at providing world-class customer service to the members, providers, and customers. These services include the following:

  • Welcome Calls – Welcome calls are made to the member and are the department’s way to thank the member for joining the plan, give them an overview of the program, and answer any questions that they may have regarding their new plan.
  • Health Assessments – Calls are made to the member and entail the call representative finalizing a health assessment, which enables the care management team to have specific information that will help in being proactive regarding treatment plans. A health assessment can either be included within the welcome call process or as a separate call.
  • Member Engagement – Based on a member’s response to health assessments or other criteria identified by the client, the team discusses case/disease management programs available to members in an attempt to drive case management participation. This alleviates the care management team’s need to focus on initial outreach. Throughout 2014, the team was able to maintain a 55% average acceptance rate during outreach to members with low, medium, and high risk acuity.
  • Demographic Research – In situations where a member’s demographics are not accurate and that do not allow the call center to be successful in making welcome calls or health assessments, the team calls primary care providers and/or the member’s pharmacy to obtain correct contact information.
  • Claim Benefits and Status – The call center team is able to provide detailed and accurate information regarding plan benefits and claim status for health plans. The types of plans handled by the team include Medicaid, limited medical, major medical, dental, life, and prescription plans.
  • Returned Mail Calls – If mail is returned, the call center performs the demographic research to obtain an accurate address so the mail can be redirected to the correct location.
  • Extended/Weekend Hours – When required by the client, the call center extends its hours beyond the normal call center hours and opens for weekends. The current call center hours are Monday through Friday from 8 AM to 8 PM Eastern.
  • After Hours Nurse Line – If the need arises, we have an After Hours Nurse Line where members are able to get quick answers to medical-related questions.

Emphasis on Quality

The call center places a high emphasis on quality. Through stringent hiring practices, thorough training, and continuous feedback, the department is able to achieve remarkable results for quality. The department’s average quality score for 2014 was 95.7% accuracy.

Results Driven

By proactively and aggressively managing the call volumes and queues the department is able to produce results that routinely exceed standards in place regarding abandonment rates and the speed to answer.

The following statistics show the 2014 service levels for inbound and outbound calls and the call volumes.

 Abandonment Rate
Standard <5%
Speed to Answer
Standard <30 Seconds
Total Call Volume