As a member services leader, you understand your team’s role in member satisfaction and retention. You’re the bridge between complex health insurance plans and those who rely on them. But offering rudimentary assistance isn’t enough.
Learn four strategies to elevate health insurance member services, transforming it from a reactive call center to a proactive partner in member health journeys.
Empower Your Team with Advanced Knowledge
Apple’s Genius’ is a group of highly trained employees who provide face-to-face service at Apple Stores. They’re well-known for in-depth product knowledge and customer-focused attitude.
Those traits don’t develop overnight. Apple trains these employees on diverse topics – including how to market and sell, express empathy, and read emotional clues. The training goes beyond just the product, which may explain why a survey from 2012 found nine of every ten Apple owners are somewhat or much more likely to make another Apple purchase following their tech support experience.
Creating a high-performing member service team takes effort. Focusing that effort on continuous training and building advanced knowledge improves a team’s competency. Consider:
Going Beyond Basics
Invest in training that equips your team to navigate complex plans, healthcare reform updates, and industry trends. More knowledgeable reps resolve member interactions faster, which improves member satisfaction scores.
Embracing Technology
Leverage member portals, chatbots, and other digital tools to enhance self-service options for members. If you can leverage technology to reduce the number of low-level, frequently asked questions your team receives, they can focus on solving complex issues.
Specialization is key
Consider creating specialized teams or individuals focused on specific areas like claims processing, network navigation, premium billing, or case management. All new or less senior member service reps should have a broad knowledge, and as they learn and grow, consider having specialized paths that provide in-depth knowledge of specific topics so they can effectively handle those calls.
Prioritize Proactive Outreach and Personalized Service
Energy utilities aren’t known for their customer service. Yet, the last time I had a power outage, the utility surprised me with its proactivity. I received an email alerting me, and how long it would last. The email included an outage map where I could see the live location of workers, how many people were affected in each area, and the utility’s priorities. The proactive communication contained all the information I’d likely need to understand the outage while setting expectations for power restoration.
Proactivity and personalization are keys to improving the member experience. Here are some tips to enhance personalization and proactivity:
Leverage data analytics
Identify members with potential concerns based on claims history or gaps in preventive care utilization. Proactively reach out and offer support.
For example, you may have additional resources or programs for those with diabetes. Proactively reaching out to those diagnosed but not participating in the program can improve health outcomes and the member experience.
Segment your member base
Tailor outreach efforts to address the specific needs of different member demographics (seniors, young adults, families). One size does not fit all. Segmentation helps better address member issues.
Embrace personalization
Utilize member data to personalize communication, addressing members by name and highlighting relevant plan benefits or resources. By taking these simple personalization steps – typically easily performed with software – you’re more likely to engage the member in the content.
Focus on Member Advocacy and Building Trust
A few years ago, Costco emailed a notice that a dehumidifier I’d purchased years earlier was recalled. The email indicated to discontinue use and bring it to a local Costco. Because I’d used the dehumidifier for years, I expected them to take it for recycling. Instead, they refunded the entire purchase price.
I was shocked. But Costco’s expansive return policy is a reason that if I can make a large purchase at Costco, I usually will. I trust that they’ll refund or replace any item for any reason. Because they’ve earned my trust, the amount of money I spend at Costco has increased.
Here are some tips to help your health insurance member services team build trust with members by advocating on their behalf:
Empower your team to advocate for members
Train them on strategies to negotiate with providers or navigate complex claims denials. By advocating for members, you’ll likely earn their trust.
Become a trusted advisor
Go beyond transactional interactions. Build relationships with members and become a source of reliable information and guidance.
Gather and act on member feedback
Regularly collect feedback through surveys or focus groups. Use this data to identify areas for improvement and demonstrate that member voices matter.
Measure Your Success and Embrace Continuous Improvement
Zappos was a darling of the 2010s because of its unique approach to customer service. Instead of focusing on business goals – like selling X number of shoes – their mantra revolved around delivering happiness.
But behind the scenes, the company leveraged data to measure and improve customer service. Leveraging call recordings and transcripts, Zappos analyzed customer interactions to identify common pain points and areas for improvement. They also used sentiment analysis to gauge customer satisfaction during interactions.
This data-centric approach helped them train customer service representatives to address customer needs and improve overall customer satisfaction.
Here are some tips to get you started:
Track key performance indicators (KPIs)
Ideate the primary goals for your member service team and then create a dashboard that helps you measure your progress toward those goals. Monitor member satisfaction scores, resolution times, and first contact resolution rates.
Benchmark against industry standards
It’s good to understand your metrics, but don’t neglect paying attention to how your competitors approach member service. Understand how your department compares to others and identify areas for improvement.
Embrace continuous learning
Learning should never stop. Foster a culture of innovation and encourage your team to explore new technologies or service models to enhance member experiences. Have weekly lunch and learns presented by senior members, have managers review calls or transcripts, and highlight team members who outperform expectations and embrace continuous learning opportunities.
By implementing these strategies, you can transform your member services department into a strategic asset supporting member needs, fostering loyalty, and driving positive health outcomes. Remember, an empowered, data-driven, and member-centric team is a winning formula for health insurance member services success.
Certifi’s health insurance premium billing and payment solutions help healthcare payers improve billing accuracy while reducing administrative costs.
