Why Investing in Your Staff Will Benefit Your Members

I started my career working in social services. I wanted to change the world, as many of us do in our youth. When my family needed health insurance, I applied for a job with a health insurance company. It was an unexpected career change, but I was fortunate as I had an amazing mentor who taught me a different view point of my job. She expanded my view and taught me to see the big picture of making our members’ lives better. Was I in case management? Maybe a social worker interacting with members? No, I was a customer service representative and then an enrollment supervisor. But she gave me vision of how my job touched our members and made a difference.

Mentoring is a fine art. As the talented poet Robert Frost said, “I’m not a teacher but an awakener.” Ask yourself this, no matter your position or role, can you say that? Are you a teacher or an awakener?

It is that vision and passion that makes the difference. I learned from a few key people in my career what that looks like, and it changed my world. Today, in many ways, that skill is lacking, and it is time to bring it back. As you consider your role, and that of those on your team, what can you do to awaken those on your team to be part of the bigger change to your culture and member experience?

Some suggestions that guide me are:

Always Remember: “It’s All About the Member.” I remember very early in my career a call that impacts me still today. A member called in distraught. His wife, also a member, was dying. She was in a nursing home and didn’t have long to live. Her family had made a blanket for her, and it had disappeared. Aside from it being a participating facility, it had nothing to do with our insurance. But it had a world of impact to them. I worked for a company that valued that and allowed me to follow up to make sure the blanket was found and returned to the member. I also had the freedom to take this man’s calls as much as needed.

Systems Are Tools. Automation is great. It allows us to be efficient and focus on the things that need our attention. Auto-adjudication for claims or enrollment gives us the ability to focus on the fallout that can’t auto process. What happens often is that systems replace training and knowledge. Staff no longer know “why” the system is doing something. It makes problem resolution and oversight far more challenging as often issues are not identified quickly. Process improvement and automation are amazing tools, but don’t let them replace a knowledge and training about the behind-the-scenes requirements.

Our Staff Need Us. Management is in meetings and often behind closed doors. That leaves a gap. Where does your staff go when they need help? Is it counted against them to ask for help? Does your staff feel like you understand their barriers and are working to eliminate them? Do you give them the opportunity to grow and be challenged in a supportive environment, or is it more “sink or swim”? If we really want member-focused staff, we need to be staff-focused managers.

First Call Resolution Is Only Valuable When It Is the Right Resolution. Is first call resolution more important than the right resolution? More and more I am hearing plans say they are not giving their members homework. What a refreshing philosophy. You may not be able to fully resolve an issue on the first call because more research or activity is needed to prevent that “homework.” Sometimes that is what excellent service requires.

My team includes some of the most talented, engaged people in the industry. They understand mentoring and strive to bring that to each project. A recent example is a colleague of mine. She recently worked with a client and had a location called “Katie’s Learning Lab.” Operations staff could stop in and ask questions and get clarifications when they didn’t know what to do. It gave a sense of security; there was a place to get help without judgement. Katie invested time with the staff. She gets it. She knows that until staff have a mentor to show them their place in our members’ world, it’s just a job when, in reality, it’s people’s lives. And we have the amazing ability to positively impact them.

We understand enrollment and customer service representatives as well as analysts well-versed in MA (and engagement with seniors) are in short supply in most markets.

If interim staffing to support your front line staff is what you need to ensure a successful enrollment season, GHG can enhance your team with our own mentors, providing knowledgeable, effective assistance and an eye for detail from staff with decades of experience.

Here are suggestions to ensure your team is effectively trained to make every member touch count.


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