The Healthcare Industry is facing complex challenges that will affect the ability of contact centers to effectively service their callers at a manageable cost. The introduction of patient privacy regulations, such as HIPAA, the greater volume of products and services offered, and the increase in customer expectations around service levels have resulted in contact center costs rising to cover training, retention plans, and call handling.

Consumer behavior has changed to create a demand for a multi-channel experience, however, rolling this out results in a variety of business challenges that need to be addressed [1]. Additionally, consumer pressure and legislation such as Sarbanes-Oxley are placing regulatory pressures on the Healthcare industry. Contact center agents will have to ensure that they adhere to these new and growing requirements, ask more questions, cover certain information, provide disclosures, and receive appropriate approvals before viewing sensitive information [2].

Automating routine non-specialist calls, such as claim status or preauthorization, can significantly reduce the cost of call handling, assist with regulatory compliance, enhance customer service, and improve the agent and caller experience. This frees existing agents to focus on member enrolment and cross-sell additional products using a multi-channel approach [3].

Sample Healthcare Solutions

Business Drivers to Improve Service

Reduce call queues – With agents spending more time handling routine calls, queues increase and lead to caller frustration and increased cost.

Reduce call handling time – Larger call volumes mean that agents need to spend their time efficiently. Agents can spend up to 45% of their time on the phone handling simple enquiries such as order status.

Reduce cost to serve members/providers – Providers are under constant pressure to provide the highest quality service, and ensure a consistent and concise user experience, while reducing and controlling cost.

Improve enrollment and cross-selling opportunities – Your agents are often highly trained clinical nurses or customer service representatives who are tied up answering routine calls rather than handling complex enquiries or enrolling new members.

Improve customer service – The main sources of caller dissatisfaction are time spent trying to get through to a company and the associated cost, the inability to speak to someone, and the frustration incurred when the agent is unable to resolve the query [4].

A study by the Ascent Group [5] examined the characteristics of some of the companies who consistently deliver high-quality customer service. The top five characteristics believed to be critical to high customer satisfaction and service excellence were:

• Respect for employees and customers
• Empower employees to do what is right
• Customer-friendly technologies matched to customer needs and expectations
• Provide a variety of customer service options and choices for customers
• Leverage technology to improve internal processes

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