A Leading Third-Party Administrator Achieves a 10% Overall
Improvement in Call Center Performance
A leading third-party administrator (TPA), specializing in healthcare claims processing, was struggling to manage its call center operations efficiently. Providers often faced long wait times, unresolved issues, and inconsistent service, particularly when new healthcare plans were introduced without internal updates. The lack of timely information resulted in lower First Contact Resolution (FCR) rates and increased call abandonment. The TPA was operating with a 13-hour service window and found it challenging to maintain adequate staffing during peak hours. This resulted in higher operational costs and negatively impacted provider satisfaction. The TPA recognized the need for a comprehensive solution to streamline its operations and enhance service quality.
Addressing Operational Challenges in Healthcare Claims
Management
The challenges facing the TPA were multifaceted. High call volumes during peak hours led to extended wait times, causing increased call abandonment rates. The introduction of new healthcare plans without timely updates left customer service representatives (CSRs) unable to resolve inquiries efficiently, which lowered FCR rates and frustrated providers. Additionally, when claims were incorrectly denied or left pending, CSRs had to manually escalate the cases via email, taking them off active calls and further reducing service levels. Compounding the problem was absenteeism—both planned and unplanned—which led to high shrinkage rates, making it difficult for the TPA to maintain optimal staffing levels throughout the day. The company needed to improve operational efficiency by managing call volumes more effectively, reducing shrinkage, and optimizing workforce productivity.
Implementing Innovative Solutions for Enhanced Call Center
Performance
The TPA began its operational transformation by implementing
several key strategies aimed at improving call center performance. The company
first optimized its break and lunch schedules using workforce management
software to ensure agents were consistently available during peak hours. This
restructuring significantly reduced call abandonment rates by ensuring that
enough agents were on hand to handle the increased call volume. Next, the TPA
introduced standardized email templates to manage claim denials and escalations
more efficiently. This allowed CSRs to handle more calls while staying on task,
improving overall service levels. Shrinkage forecasting tools were introduced
to predict absenteeism, enabling the TPA to better align staffing levels with
anticipated call volumes. To further increase flexibility, the TPA
cross-trained its agents, ensuring that they could handle multiple call types
and take on different roles during spikes in call volume. A detailed analysis
of call flow data led to the reconfiguration of shifts, with staggered start
times designed to ensure that agents were available when demand was at its
highest. Finally, the TPA invested in hiring skilled agents and providing them
with comprehensive training in customer service, system navigation, and
healthcare plan regulations.
Transformed Call Center Operations Yield Tangible Results
By implementing these innovative solutions, the TPA saw immediate and substantial improvements in its call center operations. First Contact Resolution rates increased, wait times decreased, and provider satisfaction improved significantly. The optimized break schedules, standardized escalation processes, and data-driven staffing adjustments contributed to greater overall efficiency. The TPA’s ability to handle high call volumes more effectively not only improved service quality but also reduced operational costs. The company now operates with greater flexibility and efficiency, ensuring that providers receive timely and accurate responses to their inquiries.
Below are the significant results achieved by the TPA,
showcasing a 10% overall improvement in call center performance:
FCR Improvement: 10-12% increase
Call Abandonment: Reduced by 50%
Wait Time: Reduced by 10-15 seconds
AHT Efficiency: Improved agent efficiency
Conclusion:
