The Importance of a Proactive Call Center

November 13, 2014
|In Uncategorized, Sales & Marketing, Strategy, Brain Food
|By GHG Advisors

During the AEP we know how critical a role our Member Services team plays. During this time, they are integral to helping prospective enrollees understand the benefits of your Plans, and  play an important part in the retention of your current members. Having a strong proactive Member Call Center is crucial in today’s environment. Test your call center — see if they pass the test. A proactive Member Service Call Center Department should at a minimum, do all of the following:

  • Highly trained call center representatives develop “one on one” member relationships
  • Becomes a one stop resource for seniors (meal on wheels, etc.)
  • Track and trend Members’ problems and resolutions (problem solving)
  • Reduce members voluntary disenrollment with focus on first-time call resolution of Member’s problems
  • Take the time to educate members (benefits, Providers, and Claims)
  • Look for opportunities to engage the member in Care Management services
  • Provide outreach reminders to members (Member Newsletters, appointment reminder postcards, etc.)
  • Proactively, through outbound calls, identify first level problems and implement resolutions
  • Provide new members orientation (an educated member is a happy member)
  • Provide consistent training to help reduce the number of members’ appeals and grievances
  • Have Quality Improvement initiatives consistently in play to help improve the Star measures
  • Support members in accessing care, even making appointments for them if necessary

If you can answer yes to all the bullets above regarding your current Member Service/Customer Service Department, then you are on the right road to increased retention. If not, then leveraging member’s satisfaction is an important retention tool that should be looked at going forward. Now is the time for forward thinking initiatives!

Stats: 30% of Medicare beneficiaries are enrolled into a Medicare Advantage Plan (MA/MAPD). And over 15% of Medicare Advantage Companies Fail to meet the government standards for customer service through a call center for 2014. (Source: https://www.healthpocket.com/healthcare-research/infostat/medicare-advantage-customer-service-ranking.)

Resources

John Gorman, GHG’s Founder and Executive Chairman discussed why assessing your current position and developing new strategies to drive profitable market share growth is crucial for continued success. Become a member of the Point to access the webinar recording >>

Gorman Health Group can work with you to understand your market, mining demographic data for opportunity and finding the gaps in the competitive field into which your plan can fit. Visit our website to learn more >>

Save the Date for the Gorman Health Group 2015 Forum. Join us April 7-9, 2015 at the Gaylord National Resort and Convention Center in National Harbor, MD. Learn more about the event >>