Company: Optum Local Care Delivery, Phoenix, AZ
Company Description: Optum Local Care Delivery is a hybrid organization offering health and wellness initiatives to members, as well as claims payment, physician networks, customer service, benefit interpretation, and community centers for members. Our company was founded in 2010, and works with patients to improve their interactions with the healthcare system.
Nomination Category: Customer Service Categories
Nomination Sub Category: Customer Service Department of the Year

Nomination Title: Putting the Customer in the Center

Tell the story about what this nominated organization/department has achieved since January 1, 2014 (up to 650 words). Focus on specific accomplishments, and relate these accomplishments to past performance or industry norms.

At Optum Local Care Delivery our service model is central to every process, policy, and business goal. Most companies state customer service is key, but few companies structure organizations in a manner that makes customer service the focus.

Our service model, the way we handle customer service, is central to everything we do.

Accomplishments in customer service during 2014 include: above industry standard customer satisfaction scores, exceptional internal quality results, a highly scored Ernst & Young audit of internal quality processes that included commentary stating aspects of our auditing program were innovative and unique methods of auditing to achieve service satisfaction, and launch of an expanded training program targeted to set and enforce the service expectation.

Our Service Model – the standard is a set of expectations, policies, and metrics by which our company measures the internal and external impact to customer service. Each metric in every department is tied back to customer service or satisfaction.

Examples of this dedication include:

In the service model, if a Service Advocate (SA) gives the caller any homework, the SA would fail the quality audit. Giving homework can include, using phrases like “You could” or “You should.”

Other organizations may offer to complete a transfer for a caller. Our SAs are required to reach out on behalf of the caller and resolve any issues for the caller. This is true whether the issue is resolved internally within our company, or requires us to work with entities or businesses outside of our company.

Whether the SA offers a call-back when the issue is resolved, or the caller wants to remain on the line with the SA, the issue is resolved in one interaction for the caller. 

By taking ownership of the issue we work to offer true One Call Resolution. We empower our SAs to ensure when we are called, we handle the issue.

During interviews for new customer service employees, specific questions are asked to gauge how a candidate would handle the level of empowerment given at Optum Local Care Delivery.

Example of a typical scenario:
“A member has called and stated they have a flat tire and won’t make their doctor appointment. What do you do to assist?”

Common responses include thanking the caller for the notice and possibly helping the caller reschedule. If that is the extent of the candidate’s response, we pass on that candidate.

Those answers are the below the minimum expectation for this scenario. If the candidate goes on to explain how they would help the caller resolve their issue (by offering to call a tow truck or emergency assistance), then we take a closer look at the candidate as a potential fit.

Rescheduling the appointment is the easy part – taking care of the caller is the expectation.

In Quality Auditing there are processes put in place to directly support customer satisfaction beyond what is standard in other industry auditing programs.

For example, Auditing has a claim audit known as the Member Liability Denial audit. The audit is a 100% review of all claims that deny stating the member is responsible for payment. Those claims are audited before being released to the member. This audit is not common practice within health insurance companies.

We will only deny a claim for member liability if we are 100% certain a member
is responsible. This reduces calls (with members upset claims were not paid), and it increases our member loyalty and satisfaction. Our members are certain the information is correct.

In 2014, a new training program was launched centered on customer service skills, and ensuring every employee understood that the service model applied across the enterprise.

The training incorporated examples, sensitivity training, and blended-learning experiences that impact every department, not just customer service. The training requirement and service model apply to every area, even those without direct external customer contact.

In bullet-list form, briefly summarize up to ten (10) accomplishments of the nominated department since the beginning of 2014 (up to 150 words).

- Monthly Customer Satisfaction scores exceeding 97.7%
(measured against an industry standard of 94% for other healthcare entities: Source Forbes.com “Customer Satisfaction by the Numbers: An Industry Breakdown”; Genesys Global Survey)
- A Net Promotor Score (NPS) of 72
- 2014 Internal Quality Score of 97.39% on a “stricter-than-most” quality scorecard
- Greater than 90% in First Call Resolution metric for provider calls
- Maintained an :19 second Average Speed to Answer (ASA) in 2014 even with high levels of customer service
- Opened a new Patient Acquisition and Retention call center