Health Insurance Call Volume Increasing: Best Practices to Achieve Success

By Sarah Hedayati

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: Since January 1, 2011, more than 10,000 baby boomers have reached the age of 65 every day; this will continue 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.

Healthcare 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 Increasing Call Volume? The increase in call volume has the potential to increase costs, reduce customer satisfaction, and increase the number of callbacks.

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 Callbacks: Callbacks may increase 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 Increases? 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 instructed on how to control the call, be patient, express empathy, and communicate in a simple and clear manner:

Control the Call: Customer service representatives (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. The examples below show the difference between open and closed questions.

Caller: “I’m retiring next year, and I’m concerned about healthcare 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.

Good 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 center 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 healthcare 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 healthcare 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 callback.

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

[From the October/November 2012 issue of AnswerStat magazine]