The challenge

Members of a large regional payer’s group for individual or Medicare plans were receiving unsatisfactory support. When reaching out to the company for assistance setting up an account, resetting a password, navigating the website, making payments, etc., the members faced long wait times and inconsistent answers from the member care associates. Member sentiment was quickly sinking.

The vendor partner overseeing the associates struggled to meet performance and service level targets, much less make improvements. The company needed a new partner who could deliver a reliable and high performing member experience.

Our solution

Based on TTEC’s track record of delivering an excellent member experience, the client turned to us for assistance transforming its member support. In true TTEC fashion, our first step was to understand the contact center’s current state. This included deep dives into configuration details, conducting interviews with employees, as well as shadowing associates to define the current working issues and required future capabilities.

We discovered multiple redundant processes and non-value steps in the call flow that negatively affected associate performance. Other challenges included understanding processes, availability of information, and defined job scope.

We recommended removing unnecessary validation steps. For instance, the associates were not trained to answer membership or claims questions so some of the HIPAA information didn’t need to be captured and those calls were instead transferred to an appropriate department.

We also worked with the client to define the associates’ job scope and monitor calls to ensure that items they should not be addressing were appropriately transferred.

In addition, we recommended setting up regular meetings with the team leads to discuss expectations and call flow. Information from these biweekly calls helped to identify uptraining and huddle topics, which were rolled out to associates to ensure that improvement continued. To resolve the gaps in available information, we created an open discussion point that highlighted missing information so that documents could be created to fill those gaps in the knowledgebase.

We also set up a weekly meeting cadence with the client to discuss call trends, member feedback, and best practices of high performing associates for other teams to emulate.

The results

The recommendations, best practices, and insights that TTEC provided helped the associates be more mindful of the members’ time, provide accurate information, and reduce the need for multiple calls or transfers by handling the situation correctly in the first attempt.

TTEC significantly improved the member experience as measured by key performance indicators. We met quality assurance (QA) and compliance targets within 60 days of launch—a 23-point improvement from the prior partner’s performance. By eliminating redundant processes and implementing time-saving methods such as call segmentation, we reduced the average handle time (AHT) by 37.5%, resulting in a $2 million reduction in annual spend.

The client also agreed to shift some of the call volume to our offshore teams, saving an additional $1.5 million. In a true partnership, we continue to support the client with proactive and innovative solutions, ensuring its members receive excellent support, every time.