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OptumCare - Customer Service Department of the Year

Gold Stevie Award Winner 2016, Click to Enter The 2017 Stevie Awards for Sales and Customer service

Company: OptumCare, Phoenix, AZ, USA
Company Division/Group: OptumCare Operations
Company Description: Part of United HealthGroup, OptumCare provides services to members and prospective leads primarily in AZ and UT with other focus on lead generation in various markets across the nation. OptumCare Operations is comprised of several departments which include a contact center dedicated to their award-winning no-homework service model
Nomination Category: Customer Service Categories
Nomination Sub Category: Customer Service Department of the Year

Nomination Title: Our Service Model: Putting Us Ahead of the Rest

Tell the story about what this nominated organization/department has achieved since 1 January 2016 (up to 650 words). Focus on specific accomplishments, and relate these accomplishments to past performance or industry norms.

The driving force behind the success of OptumCare’s Service Center is our Service Model. Our Service Model serves as a guide and standard, which all of our Service Advocates and leaders strive to uphold and enhance. The OptumCare Service Model mirrors United Healthcare’s core company values: Integrity, Compassion, Relationships, Innovation, and Performance.

Creating a comfortable and rewarding experience for our clientele is held in the utmost regard. Service Advocates are encouraged to go above and beyond in their work, and enthusiastically treat the customer’s problem as if it were a problem of their own. An OptumCare member is never asked to do what we can do for them, and we strive to anticipate potential member concerns by placing ourselves in member’s shoes.

Our accomplishments and Innovations include:

-Monthly Customer Satisfaction scores exceeding 96%, measured against an industry standard of 94% for other healthcare entities and a corporate standard of 89%.
-Forbes.com “Customer Satisfaction by the Numbers: An Industry Breakdown”; Genesys Global Survey)
-A Net Promotor Score (NPS) of 70 – with a corporate goal of 50 and a stretch goal of 70 in 7 years.
-2016 Internal Quality Score of 97% on a “stricter-than-most” quality scorecard.
-Greater than 90% in First Call Resolution metric for provider calls.
-16 second Average Speed to Answer (ASA) in 2016 with high levels of customer service.
-A Face-to-face member survey, the results of which are used to enhance quality program, create mission statement and enhance market/member relationship.

Customer Callback Program: In the event that a member leaves a review of 95% or lower following an interaction with a Service Advocate, our leadership reviews the call, pinpoints any errors and determines avenues for improvement. Upon gaining an understanding of any missteps or oversights made during the call, the Service Advocate contacts the customer in question and actively works to maximize customer satisfaction.

During our daily interdepartmental Check-in-Call, we expand upon call trends with our organization’s departmental leaders, and efficiently resolve all issues, thereby pointedly reducing the number of obstacles our customers face in a timely manner.

Proactive Outreach allows us to solve problems preemptively. In one scenario, a number of specialty providers were removed from our plan as a result of the narrowing of our network. Our team contacted all affected members and referred them to in-network providers. This is a textbook example of our Service Model value to never ask a member to do what we can do for them.

Implemented the RESCUE Line, in which a team of tenured Service Advocates are dedicated to a phone queue, which Service Advocates can contact while on the call with the member/provider and talk through callers’ questions/concerns, ensuring correct and complete information is provided. This system helps to ensure first call resolution, creates confidence amongst the Service Advocates, and promotes team comradery.

Instead of exposing Advocates to a crash course and expecting quality results upon their introduction to the floor, we have implemented a plan that splits training time between the classroom and the Service Center floor, creating a level of mastery that is uncommon among other call centers. Segmented training program allows for smoother transition and a more comprehensive understanding of how we service our callers each time.

Our Service Advocates learn from their experiences and take part in robust customer service training, including engaging Net Promotor Score (NPS) workshops and quarterly focus groups. The focus groups provide an opportunity to air questions, concerns, and solutions to leadership. Based on the information gathered, leadership develops action plans prioritizing the resolution of any issues described and the implementation of any new innovations. This increases employee engagement by making everyone a stakeholder in the process.

Our commitment to quality customer care, adherence to our Service Model, implementation of innovative and efficient concepts, and unrivaled proficiency serve as indisputable evidence that OptumCare’s Service Center is at the forefront of the customer service industry.

In bullet-list form, briefly summarize up to ten (10) accomplishments of the nominated department since the beginning of 2016 (up to 150 words).

-Monthly Customer Satisfaction scores exceeding 96%, measured against an industry standard of 94% for other healthcare entities and a corporate standard of 89%.
-Forbes.com “Customer Satisfaction by the Numbers: An Industry Breakdown”; Genesys Global Survey)
-A Net Promotor Score (NPS) of 70 – with a corporate goal of 50 and a stretch goal of 70 in 7 years.
-2016 Internal Quality Score of 97% on a “stricter-than-most” quality scorecard.
-Greater than 90% in First Call Resolution metric for provider calls.
-16 second Average Speed to Answer (ASA) in 2016 with high levels of customer service.
-A Face-to-face member survey, the results of which are used to enhance quality program, create mission statement and enhance market/member relationship.