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 & Call Center Awards Achievement Categories
Nomination Sub Category: Customer Service Transformation Award
 Nomination Title: Service Model Transformation
- Which will you submit for your nomination in this category, a video of up to five (5) minutes, explaining the nominated achievement since July 1, 2022, 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 organization: its history and past performance (up to 200 words):
Total 200 words used.
UnitedHealthcare Provider Service Operations (PSO) helps people get access to life saving healthcare services by delivering multichannel service experience to healthcare professionals. A team of 5,500+ PSO Contact Center Advocates and backoffice specialists handle inquiries via phone, chat, and e-mail covering a wide spectrum of topics such as benefits, claims, eligibility, denials, prescriptions, authorizations for procedures, and referrals.
Over the past three years, PSO has shed its traditional and fragmented service model, replacing it with a streamlined and technologically advanced approach. This approach has resulted in record breaking performance in the Provider Contact Center and our Provider Resolution Center backoffice teams. The Provider Contact Center implemented an industry leading alternative for provider communication. We can engage providers through Chat, Chat Bots, Portal, and APIs. Contact Center advocates also use Advocate Assist – and AI driven tool predict responses based on historical interactions. Additionally, Advocates have a new unified desktop that consolidates 100+ different systems and tools, simplifying their job. PSO created the Provider Resolution Center (PRC) that acts as nerve center for all provider issues across all enterprise partners and functions. PRC Leverages advanced analytics, intelligent education campaigns, and systemic resolution processes to reduce abrasion, rework, and repeat contacts.
- Outline the nominated achievement since July 1 2022 that you wish to bring to the judges' attention (up to 250 words):
Total 235 words used.
Since July 1, 2022, Provider Service Operations (PSO) has transformed into an industry leader in digital service capabilities, with substantial improvements in employee and provider experiences. PSO prioritized employee empowerment through targeted initiatives and shifted from a reactive to a proactive approach in resolving provider issues by implementing the Provider Resolution Center. This transformation has streamlined provider interactions, expanded employee development, and delivered significant operational savings, maintaining strong key performance indicators (KPIs).
Operational metrics have also improved significantly following the implementation of digital initiatives in 2023. Call volumes decreased by 13.8% year-over-year in 2024, driven by increased chat adoption and digital containment. Provider Chat utilization rose from 3.2% in 2023 to 13.8% in 2024, contributing to a digital containment rate of 10.4% YTD, surpassing the goal of 9.3%. The digital contact ratio also exceeded expectations at 21.6 YTD versus a target of 19.98. In addition, the contact rate is projected to decrease by 13% in 2024 compared to our 2023 forecast. These efforts resulted in a Net Promoter Score (NPS) of 85.0 YTD, a 1.1-point increase, and a User Experience Score (UES) of 97.4%, up 0.2%.
The Provider Resolution Center (PRC) implemented a holistic model addressing intake, operations, prevention, detection, and partner management. This approach eliminated 2.9 million abrasion moments and delivered $18M in rework cost avoidance, solidifying PSO’s leadership in operational excellence.
- Explain why the achievement you have highlighted is unique or significant. If possible compare the achievement to the performance of other players in your industry and/or to the organization's past performance (up to 250 words):
Total 248 words used.
PSO maintained remarkable results while adapting to significant changes in the service model, technology, tools, resources, processes, and job functions. Through this change the team consistently led the company in employee experience results, achieving an 84.7% response rate in the May 2024 survey. From 2022–2024, PSO surpassed UnitedHealthcare Operations benchmarks across key areas, with an Employee Experience Index (EXI) of 81.5% (vs. 75.4%), a Manager Effectiveness Index (MEI) of 90.4% (vs. 86.3%), and Intent to Stay at 92% (vs. 90.6%).
In the past 2 years PSO has implemented initiatives such as:
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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.
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Provider Chat: Allows advocates to engage with multiple providers in real-time.
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AI-driven tools (bots): Our Product Team released four new AI-driven bots that assist advocates in handling complex issues. These include the 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. These bots have led to a 10.4% containment rate YTD, handling 487.6K chats and reducing the transfer rate by 39% from January to September 2024.
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Spire (One-Stop Desktop): Consolidates 100+ systems into a single platform, simplifying both advocate and provider interactions.
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Multi-Skilled Advocate Model: Trains advocates across all service lines and chat, reducing transfer needs and boosting Net Promoter Score (NPS)
- 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 115 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
- Provider Resolution Center (PRC) Overview Video – Introduction to PRC
- PRC Video – Employees share experiences working in the Provider Resolution Center
- 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
- PSO Employee Engagement Video – Showcases PSO employee engagement and social responsibility events
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