Case Study

Today’s healthcare payers are taking a more customer-centric approach. This means ensuring strong provider and member engagement. For one Fortune 200 payer client, HGS provides critical, consumer-centric care that consistently exceeds provider and member expectations, while simultaneously driving cost-containment and stellar service levels from our Jamaica location. One key ingredient in the winning formula is the unique disposition of the local agents—who are ideally suited to customer care with a natural curiosity and friendly, compassionate nature.

Objective

With a 10-plus year strong and thriving partnership as a foundation, HGS and a top five healthcare payer in the U.S have realized significant success with a nearshoring service expansion. The client and HGS understood our Jamaica site as one with key strengths to meet unique and evolving marketplace needs. Some justifications for this strategy were:

  • Rightshoring center of excellence for healthcare payers
  • Customer care and domain expertise
  • Empathetic agent profile
  • Low attrition (<4% per month)

Challenge

HGS was challenged to help the client improve both provider and member satisfaction scores. Our Solution To assist with accomplishing the client’s goals, HGS has leveraged our location and comprehensive, tailored solution comprising of strategic workforce management, operations, hiring, and training.

WFM: Our workforce management team ensures accurate staffing is planned for each hour of the day, based on call volume trends and service level percentages. We have identified that there is an inverse relationship between provider queue wait time, and the Customer Effort parameter. As such, HGS ensures there is enough staff to handle provider calls in a timely manner. This positively affects the overall provider sentiment post client calls.

Operation/Governance: To assist with operational oversight, HGS employs the leadership of three assistant operations managers to run the client’s day-to-day operations. Further to this point, HGS employs a ratio of 1:15 team leaders to customer service representatives (CSRs). This has allowed our support team to develop and nurture personal relationships where each team leader is aware of the specifics of any challenge CSRs may experience. Our work-life flexibility encourages shift-sharing between agents and inspires optimal performance. This is an example of the HGS Jamaica people-focused culture, which directly affects employee morale, engagement, and performance

The HGS philosophy behind the people-focused culture is that happy team members will result in Very Satisfied Providers (VSPs). The lines of business are grouped, and managed as follows:

  • Pre-Service
  • Post-Service, Coalition, and Hospital Calls
  • Dental, Group Medicare, and IPA Calls 

Hiring: HGS collaborates closely with the client’s Resource Management Department to recruit and hire qualified personnel for the Provider Customer Care (PCC) team. Initial interviews are conducted by members of the human resources team based on the specific hiring criteria for each LOB. For example, we have found that persons who are highly analytical are best suited for our PostService Team, which resolves claims inquiries. 

For complete alignment with the client’s needs, preferences, and culture, HGS final interviews are conducted by the assistant operations managers, as they are best aware of the personality types that will result in job fit, and by extension, retention, and performance for their respective lines of business. 

Training: HGS’s Vendor Fundamental Training lasts for 10 days, and is the agent’s first exposure to the internal customer satisfaction program. This starts on day 2 of onboarding. The survey they will be responsible for is explained and then the agents are linked to mock call scenarios, which are conducted by the trainer as a part of our Introduction to the Customer Service module.

On Day 11, each client PCC training group begins to learn about the various products and plan offerings around which providers queries revolve. This is referred to as PST (Product Specific Training). Throughout the duration of PST, recorded calls (screen capture included) are played via our Verint call database, and a call review session is done with the class. When coupled with our mock call scenarios, this level of call exposure sets the expectation of how our agents are able to provide the Perfect Experience to providers. 

Three weeks before any training group begins to take calls, they are introduced to the production floor where side-by-side job shadowing with experienced CSRs is done on average four hours weekly. Our learners begin to build a relationship with tenured CSRs as they observe then ask questions after calls. During this time we encourage sharing of tips, tricks, and best practices with the new resources.

Each PCC training concludes with a three-week nesting duration, which is considered on the job training. We slowly ease our learners into their new role with calls being cushioned by pre-shift, mid-shift, and post-shift huddles. HGS quality analysts are present and give coaching/commendations, while the trainer awards prizes and certificates to persons who received good survey feedback or provider kudos.

 
Results

HGS has driven significant success for this client—specifically for provider satisfaction. In a multiple vendor/locations environment, the client’s HGS PCC Jamaica team has consistently met CSAT – Top box goals and has held #1 spot for 27 out of 31 months of operation. ​ 

In July 2017, the HGS Jamaica team earned preferred provider status, by setting a record customer satisfaction performance, which is the highest score in the history of the client’s PCC operations, across all vendors.

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