November 1 calendar with clock behind it

Exceeding open enrollment goals with outsourcing

Healthcare companies across the U.S. have their sights set on November 1. The date marks the open enrollment period for 2020 health insurance coverage, where customers have a month and a half to make changes to their plan.

The calls typically come rolling in several months ahead of time, as people begin researching coverage and plans. Additionally, Medicare recipients and people who qualify for special enrollment — for instance, people who just got married or had a baby — have earlier enrollment dates. These factors combined drive an influx in call center volume from as early as August onward.

During this period, it's not uncommon for insurers to see their normal customer call volumes double. This puts major strain on customer service departments, with some providers having to triple their staff numbers to meet the demand.

Open enrollment is a chance for health insurance brands to prove themselves to consumers, delivering top-notch service in a time-sensitive environment. Outsourcing customer care is one of the ways providers try to get ahead of any challenges, but this means success will be based on the effectiveness of the vendor. As such, partner selection isn't a decision that should be taken lightly.

To ensure your outsourcing provider can handle your company's high volumes with knowledge, skill and ease, be on the lookout for the following characteristics.


How flexible is your potential outsourcing provider? This question is a critical one to ask, says Pat Mallon, VP of business development, healthcare, at TELUS International. "Flexibility means having the ability to staff up and down as needed for efficiency," he says.

Being flexible takes understated skill. It requires experience, expertise and industry heft to dynamically staff according to expected demand.

Look for a partner that determines up front how many people a health insurance provider will need based on an in-depth analysis of call projects, projected handle times, hours of coverage, shrinkage, projected attrition and more. This data can then be used to make headcount projections and devise an accurate staffing plan.

Having a strategic approach like this allows health insurance providers to maximize agent utilization and productivity. That's a huge advantage when query volumes alternate between low valleys and high peaks — often switching between them with very little warning.

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During periods of high demand, technology can be a key differentiator between companies, and there's no truer litmus test for innovation in healthcare customer service than during open enrollment.

According to Mallon, open enrollment is a sterling opportunity to integrate next-gen technology into the customer experience in order to improve consistency and reduce operational costs. Conversational bots and AI-driven intelligent FAQs are good examples of how technology can be applied in crunch times; helping to sort queries, answer basic questions and route calls.

"The name of the game is eliminating escalations, improving access to information at the member level, making sure you're getting difficult calls to the right channel and bleeding off non-complex calls to technology to free up agents for those who need it most," Mallon explains.

Additionally, it's important that your outsourcing partner knows your plan's star rating — Medicare's rating system for health plans — and devises a strategy with measurable KPIs to maintain or improve it. This can be achieved by using cutting-edge technology that can analyze the ensuing customer data.

"In a perfect world, all basic questions would be driven to self-serve. That would free up voice agents to handle more complex calls that really require a human touch," says Mallon.

Privacy and security

Before you select an outsourcing partner, a critical consideration is that it checks all of the boxes when it comes to privacy and security. Because agents will be handling calls related to consumer health and sensitive personal information, they must be HIPAA-certified and operate in a HIPAA-compliant environment.

This should be the case for both nearshore and offshore sites. By making sure your partner is HIPAA-certified, you can avoid the risk of violation and breach fines, both of which stand to negatively affect your healthcare brand.

World-class service delivery

A big part of delivering world-class service, particularly in the healthcare industry, is employing qualified agents who also have the necessary soft skills like empathy. "You could be talking to somebody who is very sick and wants to know if chemotherapy will be handled under a new plan," Mallon says.

It's also common for seniors to crave lengthy conversations, so agents must be patient and understanding. "They're shopping for health insurance, but they also want human contact," Mallon says of senior callers. “The ability to come across as warm and caring is a product of good training and selection. With human capital, you don't just want to find people, but the right people."

Learning services

Finally, a good outsourcing partner will have mastered the art of agent training. With little time to get new agents up to speed on health plans, condensed training modules are a common solution — but these must be just as effective as onboarding teams using longer, more intense programs.

"We typically create an abridged version of training," Mallon says. Often, a highly comprehensive training course can be successfully completed over the course of just a few weeks.

This period is especially critical, adds Mallon. "Once agents are in their seats they're constantly on that flywheel." In other words, agents will be bombarded by calls and must be prepared to manage the onslaught of questions without losing their footing.

With the open enrollment period just around the corner, and call volumes starting to escalate, consider the value of working with an outsourcing partner. A well-researched partnership that can deliver on your needs will have a positive impact on your customer experience and your brand.

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