Case Study

Achieving Breakthrough Member CSAT for Leading Payer



As one of the world’s largest healthcare payers, this HGS client works closely with brokers and consultants to develop innovative programs, help individuals and families improve their health, well-being and sense of security—and lower their medical costs.

In 2015, the client was transitioning to more stringent CMS requirements, with accounts monitored according to additional audits. HGS was a partner of trust and preferred vendor to lead a member satisfaction turnaround, supporting remediation work with voice support for the client’s Medicare base. The client called on HGS to help troubleshoot key operational and member satisfaction weaknesses.

How We Do It

HGS responded from our El Paso, Texas site, employing an HGS proprietary training methodology for agents. This new, interactive training approach, focused on the senior citizen market and their needs, incorporates sensitivity, empathy, coaching, patience, and accountability. The real-world modules are designed so that agents experience firsthand the specific conditions of the client’s Medicare members—creating environments for the agents where they are sensory or physically challenged. These activities create agent knowledge and understanding of Medicare members and their health profiles—from arthritis to effects of hearing, vision, or other sensory loss.

In this key area of opportunity, HGS has proposed to add value to the new CX measurement approach with defect analysis and action planning. HGS can deploy resources to deep dive into calls using raw survey response data and applying mutually agreed rules, classifying defect reasons into HGS errors and client-controllable issues related to process, technology, or customer limitations. Data mining will help develop action plans to reduce HGS controllable defects and further improve member experience. HGS can also provide advanced text/speech mining capabilities on survey responses to elicit additional insights and market experience areas.

Business Result

HGS has driven a dramatic NPS improvement, with a jump from 8.2 to 8.6 in 2017 alone. However, a three-year analysis shows that HGS’s threemonth average from May to July 2017 is a 33% increase from HGS’s 6.47 score (a passing score is 5.8) in 2014. With these showcase scores, HGS demonstrates a real outcome of member engagement and satisfaction turnaround for the client, with members increasingly recommending this payer client to friends and family members. Additionally, HGS’s CSAT score has spiked at 3.8 out of a possible 4. The CSAT success is directly attributed to members’ positive feedback in areas of agent courtesy, knowledge, and reduced customer effort. Finally, from an operational perspective, the same HGS training approach that has driven NPS and CSAT success has resulted in a call quality score of 97% (from 95.33%), helping the client comply with the stringency of requirements and significantly reduce CMS complaints — in fact, by up to 51%. This area of achievement has been a direct result of the client’s trust in and transparency with HGS.