Company: Unitedhealthcare Provider Service Operations
Company Description: Unitedhealthcare Provider Service Operations (UHC PSO) is business area within Unitedhealthcare. With over 6,000 global employees, we provide best in class multi- channel service to our nation’s healthcare providers. This includes answering questions, resolving issues, and processing medical claim settlements. In 2022, PSO was the recipient of an industry award for Top Global Contact Center.
Nomination Category: Customer Service Department Categories
Nomination Sub Category: Customer Service Department of the Year - All Other Industries
 Nomination Title: Unitedhealthcare Provider Service Operations
- 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 department, OR written answers to the questions? (Choose one):
Written answers to the questions
- Briefly describe the nominated department: its history and past performance (up to 200 words):
Total 200 words used.
UnitedHealthcare Provider Service Operations (PSO) is ensuring access to life-saving healthcare services through a multichannel experience for healthcare providers. PSO has a team of over 5,500 employees that builds trusted relationships with more than 1.7 million providers, assisting with inquiries on benefits, eligibility, authorizations, claims, demographics, and resolving complex issues.
Historically, the healthcare insurance industry is challenged with reactive and fragmented service models resulting in long issue resolution turnaround times, delayed claim payments, leading to a decrease in provider satisfaction. PSO has successfully taken on this challenge by creating the Provider Resolution Center (PRC) and moving our Provider Contact Center to a streamlined and technologically advanced service model. The PRC employs advanced analytics to proactively detect and prevent recurring issues, implementing systemic resolutions. Additionally, the Provider Contact Center has implemented cutting-edge communication alternatives for providers, such as Chat, Chat Bots, Portal, and APIs.
The Contact Center and PRC collaborate to address provider concerns, enabling Contact Center advocates to receive real-time assistance from PRC analysts for complex issues. This partnership has reduced resolution times by more than 20 days.
These improvements to the service model have led to high post call Net Promotor Score (NPS) of 85 YTD 2024.
- 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.
- Outline the department's achievements since July 1 2022 that you wish to bring to the judges' attention (up to 250 words):
Total 248 words used.
Our innovative service model has played a pivotal role in resolving over 26 million issues for healthcare professionals, enabling them to deliver life-saving care to 70 million UHC members. The efficiency of PSO Advocates' support ensures that critical healthcare services remain uninterrupted and accessible to those in need. Notable achievements include:
- Provider Resolution Center: A pathway for call advocates to get real-time support with complex provider issues, reducing some resolution times by over 20 days
- Provider Chat: Allows advocates to engage with multiple providers in real-time.
- Chatbots: Released four new AI-driven bots that assist advocates in handling complex issues. These include the Prior Authorization (PA) Code Check Bot and PA Status Check Bot for prior authorization checks, as well as the Portal Registration Redirect Bot and Unauthenticated Redirect Bot for guiding users to self-service portal pages.
- Advocate Assist: An AI-powered tool that predicts responses, empowering advocates with enhanced communication skills for personalized service.
- Spire (One-Stop Desktop): Consolidates 100+ systems into a single platform, simplifying both advocate and provider interactions.
- Multi-Skilled Advocate Model: Trains advocates across all service lines and chat, reducing transfer needs and boosting Net Promoter Score (NPS)
- New Team Lead Role: Hired via promotion, 93 team leads that has led to a 20% increase in development time, a 14.9% decrease in quick quits.
In addition, PSO has received top honors, including the ICMI award for best large global contact center in 2022 and a Gold Stevie Award in 2023 for Contact Center of the Year.
- 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 80 words used.
- Make it Matter Video – Video showcases PSO’s Make it Matter commitment to providers they serve.
- PSO Journey Videos (3) – Showcases employee sentiment around the PSO model transformation and career development
- 2024 Accomplishments – Detail of 2024 Accomplishments
- Who We Are Presentation – Details of initiatives and performance
- PRC Case Studies – Case studies PRC issue detection and prevention process that reduces resolution turnaround times and drives cost savings and avoidance
- Performance Dashboards – Details PSO key performance metrics
- 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 department's past performance (up to 250 words):
Total 248 words used.
The achievements in PSO are uniquely impactful because they occurred during a time of unprecedented change to our service model, and we were still able to maintain remarkable results in employee satisfaction, provider satisfaction, and operational metrics.
- Reduced Voluntary Attrition by 3.4%, our EXI score of 79.2%, MEI score of 89.4%, Inclusion score of 86.3%, and Intent to Stay score of 90.3% were all 3% above the UHC Operations benchmark
- Our digital-first approach resulted in record-breaking metrics, including an NPS of 85.0, an all-time low transfer rate of 8.5%,
- The implementation of the PRC was a comprehensive approach that encompassed various aspects including intake, operations, prevention, detection, and partner management. This holistic model resulted in the removal of 2.9 million abrasion moments and $18M rework cost avoidance.
- Contact rate is projected to decrease by 13% in 2024 compared to our 2023 forecast
- Delivered $44 million (gross) SG&A savings through meticulous financial management of headwinds and cost-saving initiatives, leveraging innovative technologies, cross-functional collaboration, and proactive workforce management
- Since implementing our digital initiatives in 2023, call volumes decreased by 13.8% YoY in 2024. This decrease was driven by increased chat volumes and digital containment, resulting in an NPS improvement
- The deployment of Provider Chat has seen a significant increase from 3.2% in 2023 to 13.8% in 2024 in terms of total contacts. Furthermore, the digital containment rate currently stands at 10.4% year-to-date, surpassing the goal of 9.3%.
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