Company: UPMC Health Plan, Pittsburgh, PA
Company Description: UPMC Health Plan is among the nation's fastest-growing health plans. It is owned by UPMC, a world-renowned health care provider. The UPMC Insurance Services Division offers a full range of group health insurance, Medicare, Special Needs, CHIP, Medical Assistance, behavioral health, employee assistance, and workers' compensation products and services to over 3.6 million members.
Nomination Category: Customer Service & Call Center Awards Team Categories
Nomination Sub Category: Back-Office Customer Service Team of the Year - Other Service Industries
 Nomination Title: Accelerating Excellence in the Back Office
- Which will you submit for your nomination in this category, a video of up to five (5) minutes, explaining the achievements since July 1, 2022 of the nominated team, OR written answers to the questions? (Choose one):
Written answers to the questions
- If you are submitting a video of up to five (5) minutes in length, provide the URL of the video here, OR attach it to your entry via the "Add Attachments, Videos, or Links to This Entry" link above, through which you may also upload a copy of your video. If you are submitting written answers to the questions for this category, provide them in the spaces below.
- Briefly describe the nominated team: its history and past performance (up to 200 words):
Total 198 words used.
UPMC Health Plan, headquartered in Pittsburgh, Pennsylvania, is among the nation's top ranked health plans. Owned by the University of Pittsburgh Medical Center (UPMC), a world-renowned health care provider and integrated health care delivery system, UPMC Health Plan is committed to providing its members better health, more financial security, and the peace of mind they deserve. Our back-office Enrollment & Coordination of Benefits (COB) teams are responsible for the onboarding and maintenance of our membership to ensure critical access to care. This team’s continues successful work in accelerating excellence initiatives showcases the strengths of collaboration amongst our organization and highlights our resilient nature. It is about understanding how our work impacts our members and taking action to care for them as people. We exceed industry standards through care, efficiency and automation through agile methodology, while always aiming for a positive member experience. Initiatives are designed to leverage cutting-edge technologies, streamline processes, and empower our employees with the skills needed for tomorrow's challenges while we adapt to a rapidly changing industry. Our approach is to anticipate our members’ future questions and issues. We strive to be proactive, going above and beyond to help each member live a healthier life.
- Outline the team's achievements since July 1 2022 that you wish to bring to the judges' attention (up to 250 words):
Total 249 words used.
In the face of challenging times, excellence has become our greatest asset in the Healthcare Industry. By fostering a culture of excellence, we are navigating tough times but are emerging stronger and more united by streamlining operations through innovative solutions. Exemplary customer service begins with a commitment to workforce advancement initiatives that empower employees to excel. By actively listening to employees and fostering engagement, UPMC creates a supportive environment where staff feel valued and motivated. Career pathing exploration and comprehensive training programs are essential components, providing employees with clear growth opportunities and the skills needed to succeed. By prioritizing employee development and operational efficiency, UPMC has consistently delivered outstanding service, setting new standards in our industry and setting ourselves up for success for the future. Here are some highlights of our achievements we encourage you to delve into:
- Cost Saving initiatives totaling $1,859,154.60 resulting from streamlining or automating manual work, implementing smart workforce initiatives, and increasing real time updates for our membership. Some highlights include:
- Reduction in Return Mail ($211k)
- Leveraging Smart Intelligent Work Distribution technology ($152k)
- Medicare Enrollment Inventory Reduction ($87k)
- Mass Alert Automation ($45k)
- HIPAA Inventory Reduction ($30k)
- Expanding & leveraging COB data in new ways; resulting in $1,988,347 in claim recoveries.
- Launching a new COB Module interface, resulting in a 27% increase in productivity.
- Focusing on employee growth: 90% retention rate (2024).
- Implementing Agile Methodology & formal Ticketing systems.
- Operational structure consolidation to align and streamline similar or connected business operations.
- Reference any attachments of supporting materials throughout this nomination and how they provide evidence of the claims you have made in this nomination (up to 250 words):
Total 250 words used.
UPMC has submitted a comprehensive presentation detailing our achievements and strategic focus on enhancing back-office excellence, while ensuring effective and efficient member onboarding and maintenance. The presentation includes:
- Delivery of positive customer experiences through our NCQA Accreditation of our Marketplace EPO & PPO plans and number one member satisfaction ranking from J.D. Power. All while focusing on member onboarding and surpassing industry benchmarks through our 5-Star Rating from CMS on our UPMC For Life Medicare Plans and driving excellence through implementing workforce advancement initiatives that have already seen tremendous savings of over $1M dollars; slides 2-4.
- Commitment to supporting and valuing our team members, ensuring they feel supported and appreciated in their careers with a 94% participation rate in the MyVoice Survey and a 90% favorable rating that our supervisors care about their employees as people. In addition to promoting engagement through our LifeSolutions services RENEW Program, SkillBridge Program, championing career growth through UPMCs internal Career Ladder, and enjoying life by sharing stories through our quarterly newsletter; slides 5-9.
- Emphasis on automation and optimization of manual processes through strategic elimination of manual updates to Low Income Subsidy Updates, Social Security Optimization, and Medicare Secondary Payer Reporting achieving an annual cost savings of over $15,000. Along with transformative return on investment in automation of our State and County Code Discrepancy quality auditing and Special Needs Plan invoicing; slides 13-16.
- Showcasing the interconnectedness of our operations, positioning ourselves for future success through cost-saving initiatives, and leveraging artificial intelligence slides 15-27.
- Explain why the achievements you have highlighted are unique or significant. If possible compare the achievements to the performance of other players in your industry and/or to the team's past performance (up to 250 words):
Total 249 words used.
These achievements are unique because they represent a holistic approach to enhancing both employee and member experiences in our industry. By leveraging advanced automation technologies, UPMC has streamlined routine tasks, reduced errors, and freed up valuable time for our employees to focus on personalized care. This balance ensures that while automation handles repetitive and data-intensive tasks, the human touch remains central to our values, fostering trust and satisfaction.
Implementing Workforce Advancement Initiatives is distinctive as it demonstrates a commitment to nurturing talent and providing clear career growth opportunities, which can lead to higher employee satisfaction and retention.
Listening to employees, engaging them through programs, and focusing on their development ensures that our employees feel valued and heard, fostering a positive and productive work environment. This approach not only boosts morale but also encourages innovation and loyalty.
Streamlining automation of processes and reporting through ticketing systems is a forward-thinking strategy that enhances operational efficiency. By automating routine tasks, we can reduce errors, save time, and allow employees to focus on more strategic activities, ultimately improving service delivery.
Eliminating manual intervention in work and linking work items for efficiency is particularly unique as it directly impacts productivity and accuracy. This method reduces the potential for human error and ensures that processes are more seamless and integrated. By focusing on member experience, this achievement underscores a commitment to delivering high-quality service consistently.
Together, these initiatives create a robust framework that not only drives success but also sets new standards in the industry.
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