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Exceeding open enrollment goals with outsourcing

Posted September 10, 2019 - Updated March 2, 2022
Coiled notepad with text that reads "Open Enrollment" accompanied by various medical devices

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

The calls typically come rolling in several months ahead of time, as people begin researching coverage. 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. The combination of these factors can drive an influx in call center volume from as early as August.

During this period, it’s not uncommon for insurers to see their normal customer call volumes double. This puts major strain on customer care 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 by 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? Flexibility means having the ability to efficiently staff up or reduce numbers in response to needs. 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 upfront how many people a health insurance provider will need based on an in-depth analysis of customer contacts, 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.


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.

It is a sterling opportunity to integrate next-gen technology into the customer experience in order to improve consistency and reduce operational costs. Conversational bots, robotic process automation (RPA) and AI-driven intelligent knowledge bases are good examples of how technology can be applied in crunch times; helping to sort queries, answer basic questions and route calls.

The use of technology can help to eliminate escalations, improve access to information by making sure difficult calls are getting to the right level and free up agents to focus on customers who need more involved assistance.

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.

Privacy and security

Before you select an outsourcing partner, take the time to verify that the partner 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 onshore, nearshore and offshore sites. By making sure your partner is HIPAA-certified, you can reduce 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. Those who reach out for support may be trying to navigate complex matters for the sake of their family or their own wellness. Patience and caring support can go a long way.

Learning services

Finally, a good outsourcing partner will have mastered the art of agent training. Depending on ramp timelines, there may be a limited timeframe to get new agents up to speed on health plans. Condensed training modules are a common solution, however, these programs must be just as effective as onboarding teams using longer, more intense curricula.

The learning period is especially critical as agents will be met by a high volume of customer contacts and must be prepared to manage the 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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