The Business Challenge
With a mission of ensuring quality in the marketplace, the Centers for Medicare & Medicaid Services (CMS) heightened their focus on Medicare Advantage (MA) plans and prescription drug plans (PDP). As part of that process, CMS created a rating system for the plans that ranges from one star (the weakest performance category) to five (signifying the highest performance). These ratings serve to steer consumers to the highest rated plans; conversely, low performing plans are penalized with a requisite icon that indicates unsatisfactory quality.
After an insurance carrier providing MA and PDP plans received a Medicaid audit that yielded a two-star rating for customer service and call center performance, the organization made the decision to seek expert help implementing quality assurance initiatives. Briljent joined the team as a partner with call center quality assurance expertise, as well as extensive MA and PDP plan experience. Our breadth of experiential knowledge was a valuable addition to the project at hand.
The Briljent Solution
To meet the client’s budgetary requirements, the team conducted a pilot project that was narrower in scope than typical audit projects. The result was lower levels of data collection with less robust data, as well as reductions on the depth of analysis. However, our team used their expertise to execute a project that resulted in important insights, a preliminary overview of current service levels, and guidance for prioritizing improvement initiatives
The Task: Call Center Monitoring for Quality Assurance
In collaboration with our partners and Subject Matter Experts (SME), we developed a script and scorecard that would help gather objective and accurate information from test calls. Once that process was finalized, calls were conducted to determine:
- Accuracy and completeness of information given to beneficiaries.
- Adherence to disclosure requirements.
- Relevancy of information discussed with beneficiaries.
In conjunction with that process, our team listened to numerous hours of previously recorded calls between Customer Service Representatives (CSRs) and plan beneficiaries. This method allowed further insight into the levels of accuracy and customer service quality in the call center. Findings included:
- Inconsistency in service delivery to beneficiaries.
- Extended call-hold times.
- CSRs providing yes/no answers to callers’ questions, failing to elaborate and provide further explanations.
- Poor overall handling of Text Telephone (TTY) calls for the hearing impaired, including unanswered calls and inaccurate information conveyed to beneficiaries.
Data from the calls was gathered and analyzed, yielding a result consistent with the Medicare audit findings. To help our client reach the highest levels of service quality, our team created a user-friendly report outlining numerous changes to resources and practices:
- Create scripts and content management systems
- Develop self-monitoring tools
- Live coaching
- Calibration sessions
- Comprehensive re-design and CSR re-training of the TTY system and associated processes
Our recommendations were well received by our client, who was enthusiastic about our suggestions for implementing quality assurance. Currently, there are prospects for our team to conduct similar activities for the client in additional call centers.
Brilliant Results
For the Briljent team, this project allowed us to utilize our Medicare expertise, as well as our proficiency in call center quality assurance initiatives. This was a particular asset in the narrow scope of the project, in which our experience allowed us to aid our client as they strived to increase the quality of service to Medicaid beneficiaries. Helping our client pave the road to success was a highly rewarding experience for our team.