Health Insurance Call Volume Increasing: Best Practices to Achieve Success


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Did you notice an increase in call vol­ume dur­ing your last Open Enroll­ment period? Most health insur­ance call cen­ters did. In fact, some received such a high call vol­ume, their IVRs couldn’t han­dle the load and needed to be upgraded on the spot. Based on every­one we talk to, call cen­ters need to be pre­pared for an increase in call vol­ume each year for the next few years.

Why is Call Vol­ume Increasing?

Call cen­ters in the health insur­ance indus­try will see an increase in call vol­ume because of sev­eral shifts cur­rently tak­ing place:

Baby Boomers: Begin­ning on Jan­u­ary 1, 2011, more than 10,000 baby boomers will reach the age of 65 every day through 2030. More baby boomers will con­tact your call cen­ter with ques­tions about the coor­di­na­tion of Medicare and sup­ple­men­tal cov­er­age. They may have con­cerns about being able to afford cov­er­age. They may need advice about the best plan to cover their med­ical needs.

Health Care Reform: With the imple­men­ta­tion of the Afford­able Care Act, more peo­ple will have ques­tions about how this act will affect them. They may want to know how their cov­er­age will change or which plan is best for their needs. They may want infor­ma­tion on the best and most cost-effective plan.

What is the Impact of Call Vol­ume Increasing?

The increase in call vol­ume has the poten­tial to increase costs, reduce cus­tomer sat­is­fac­tion, and increase the num­ber of call backs.

Increased Costs: As more calls come in, call cen­ters need to make adjust­ments by hir­ing more agents, pur­chas­ing more equip­ment, and either find­ing more facil­i­ties, out­sourc­ing agents, or tran­si­tion­ing agents to work from home.

Reduced Cus­tomer Sat­is­fac­tion: With call vol­ume going up, wait times may go up as well. Insuf­fi­ciently trained call cen­ter agents won’t know how to effec­tively ques­tion callers to guide and con­trol the call. With­out the proper skills to get to the root of the customer’s prob­lem or ques­tion, the num­ber of callers in the queue will stack up.

Increased Call Backs: Call backs may increase as well due to the com­plex­ity of infor­ma­tion. The changes that come with the Afford­able Care Act will take time for agents and mem­bers to under­stand. If an agent doesn’t ade­quately answer a member’s ques­tion, the mem­ber will call back which will increase costs and stretch your resources even further.

What is the Best Way to Pre­pare for Call Vol­ume Increasing?

Now that you under­stand why call vol­ume is increas­ing and what the impact is, what can you do to pre­pare and respond? Train­ing! Cus­tomer ser­vice agents need to under­stand prod­ucts avail­able and be trained to con­trol the call, be patient and express empa­thy, and com­mu­ni­cate in a sim­ple and clear manner:

Con­trol the Call: CSRs need to learn good ques­tion­ing tech­niques. Cus­tomer ser­vice train­ing will teach agents the dif­fer­ence between open and closed ques­tions and when to use each method. Read the exam­ple below to under­stand the dif­fer­ence between open and closed questions.

Caller: I’m retir­ing next year and I’m also con­cerned about health care reform. What do these changes mean to me?

Open Ques­tion: I’m happy to help with that. What con­cerns do you have?

Open Ques­tions are ones that solicit more than a “yes” or “no” or other one-word response.

Closed Ques­tion: We have a great pack­age of ben­e­fits for you now that you’ll be retir­ing. Why don’t you tell me what health ser­vices you use most and I’ll let you know how our plan will work for you next year?

Closed ques­tions are use­ful when you want a “yes” or “no” response or when you need spe­cific infor­ma­tion from a customer.

Ques­tion­ing skills will help the agent hone in on what mem­bers are call­ing about and answer their ques­tions in an effi­cient manner.

Be Patient and Express Empa­thy: Health insur­ance call cen­ters agents need to be pre­pared to serve these diverse groups:

  • Older callers who may be ill or hard of hearing
  • New entrants into the insur­ance mar­ket unfa­mil­iar with insur­ance terminology
  • Mem­bers con­fused by more com­plex ben­e­fits and changes due to health care reform

Being patient and con­vey­ing empa­thy for the member’s ques­tions and con­cerns will help CSRs achieve cus­tomer satisfaction.

Com­mu­ni­cate Clearly: The changes brought on by health care reform will take time for mem­bers to grasp. CSRs need to be skilled at explain­ing ben­e­fits in a clear and con­cise man­ner and with­out the use of jar­gon. CSRs also need to learn how to con­firm that callers under­stand the infor­ma­tion and explain what callers can expect next so they don’t have to call back.

Increases in call vol­ume will take some adjust­ments for your call cen­ter. Plan ahead, staff your cen­ter appro­pri­ately, and train agents so you’re pre­pared to respond. Keep agents informed and up to date on the lat­est health care news so your cen­ter becomes a knowl­edge­able resource for its members.


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