Call Centers Effectively Used in the Insurance Industry

In the insurance industry, only about 20% of thethe screen using social security number, member
calls received cannot be handled by a call centerID number, or last name, the database should
using a effective database system and wellshow the particulars of the plan in which the
trained personnel.  The 20% that cannot bemember participates:  deductible, coinsurance,
handled by the call center, either during businessplan enrolled in, details of what is covered,
hours or “after hours” typically surroundexclusions, etc. 
the specifics of a claim and a claim analyst wouldIf the member has an emergency, the insured will
need to respond to the member directly.be instructed in most cases to call 9-1-1, but the
However, most calls are routine in nature and wecall center can perform pre-admission certification
have listed the most common calls received by aif there is time, and if “after hours” they
call center in the medical insurance industry below:still can collect enough information so the claim
1. Did you receive my claim?team can begin working on the case when they
2. What is the status of my claim?arrive in the morning.  For example, the claim
3. Did you receive my enrollment paperwork (forteam can contact the hospital and set up direct
my new born for example)?billing.
4. What is my deductible / how much of myOf the list above, number 6 and number 10 would
deductible have I satisfied?pose the largest problem for an “after
5. I need to find a doctor or specialist in network,hours” call center.  Telling an insured exactly
and I need to schedule an appointmentwhy a claim was denied may require the actual
6. Why was this charge not paid or denied?claim analyst that worked on the claim, unless the
7. I have an emergency.reason for the denial was posted in the system
8. Is “xyz” covered?and the call center employee could read the
9. Calling in to provide information the insuranceinformation to the employee or interpret a list of
company has requested of the insured.symbols that are often associated with claim
10. The need to add or cancel existing coverage.denials.  In this case the most common area
Looking at the calls above, even an untrained callwhere the call center could keep the process
center staff that does not specialize in healthmoving forward, would be when the insured did
insurance, and taking calls “after hours”not provide enough information for the claim to
should be able to address 60% of these calls tobe process to completion.  In this case the call
completion, assuming the database system theycenter can tell the insured what information was
are working from is state of the art andnot provided, and even collect the needed
communicates with the claim system back at theinformation.
claim processing center.  Today’s systemsFinally, most call centers are not able to add
available to the call center should show the callentirely new lines of insurance coverage, like
center associate when a particular claim has beenadding a dental program to accompany an existing
received and even provide detail such as “inmedical plan.  However, in most of these cases
process” or “complete.”  In mostthe call center can provide the employee with the
cases, the insured will be satisfied just knowingproper paperwork and again, keep things moving
the insurer has received the claim, and learningforward. 
the claim is “in process” is enough forIn summary, a good call center with the right
them to have a positive experience with thetechnology is extremely important in the insurance
insurer.industry, and for good customer service in this
Basic questions about the particulars of theindustry, the call center should be an area that
medical plan, again should be available to the callreceives significant investment.
center employee.  Once a member is located on