Call Center Services

The call center specializes in performing multiple roles that are all directed at providing world-class customer service to the members, providers and customers. These services include but are not limited to the following:

  • Welcome Calls – Welcome calls are made to the member and are the department’s way to thank the member for joining the plan, give them an overview of the program and answer any questions that they may have regarding their new plan.
  • Health Assessments– Calls are made to the member and entail the call representative finalizing a Health Assessment which enables the care management team to have specific information which will help in being proactive regarding treatment plans. Obtaining a Health Assessment can either be included within the welcome call process, or as a separate call.
  • Member Engagement – Based on a member’s response to health assessments, or other criteria identified by the client, the team will discuss case/disease management programs available to members in an attempt to drive case management participation. This alleviates the care management team’s need to focus on initial outreach. Throughout 2014 the team was able to maintain a 55% average acceptance rate during outreach to members with low, medium, and high risk acuity.
  • Demographic Research – In situations where a member’s demographics are not accurate which do not allow the call center to be successful in making welcome calls or health assessments the team will call primary care providers and / or the member’s pharmacy in order to obtain correct contact information.
  • Claim Benefits and Status– The call center team is able to provide detailed and accurate information regarding plan benefits and claim status for health plans. The types of plans that have been handled by the team include but are not limited to Medicaid, Limited Medical, Major Medical, Dental, Life and Prescription plans.
  • Returned Mail Calls – If mail is returned the call center will perform the demographic research in order to obtain an accurate address so the mail can be redirected to the correct location.
  • Extended / Weekend Hours – In situations where the client requires it the call center will extend their hours beyond the normal call center hours and open for weekends. The current call center hours are Monday through Friday from 8 AM to 8 PM Eastern.
  • After Hours Nurse Line – If the need arises we have the capability of utilizing an After Hours Nurse Line where members are able to get quick answers to Medical Related questions.

Emphasis on Quality

The call center places a high emphasis on quality. Through stringent hiring practices, thorough training and providing continuous feedback the department is able to achieve remarkable results for quality. The department’s average quality score for 2014 was 95.7% accuracy.

Results Driven

By proactively and aggressively managing the call volumes and queues the department is able to produce results which routinely exceed the standards that are in place regarding abandonment rates and the speed to answer.

The following stats show the 2014 service levels for inbound and outbound calls and the call volumes.

  Abandonment Rate
Standard <5%
Speed to Answer
Standard <30 Seconds
Total Call Volume
Jan-14 1.2% 11 21,808
Feb-14 0.8% 7 18,015
Mar-14 2.2% 19 23,024
Apr-14 1.6% 15 22,835
May-14 1.5% 15 23,362
Jun-14 1.8% 17 22,046
Jul-14 1.6% 19 23,163
Aug-14 1.5% 17 22,431
Sep-14 1.4% 15 27,906
Oct-14 1.7% 18 25,959
Nov-14 1.7% 14 18,827
Dec-14 1.4% 17 19,643
  Average Total
1.5% 15 269,019