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UPMC Health Plan - Back-Office Customer Service Team of the Year


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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 2.9 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: Maintaining A Culture Of Service Excellence In The Back Office

Tell the story about what this nominated team achieved since the beginning of July 2017 (up to 650 words). Focus on specific accomplishments, and relate these accomplishments to past performance or industry norms. Be sure to mention obstacles overcome, innovations or discoveries made, and outcomes:

At UPMC Health Plan, Enrollment and Coordination of Benefits (COB) Services teams work extremely hard to ensure the highest quality and compliance to ensure customers are enrolled timely and have access to the care and coverage they need. This effort starts by ensuring all enrollment processing is done accurately, with great care, and in compliance with all the various regulations imposed by state and federal administrators. Our COB team is the number one submitter of other coverage information to the State and our teams consistently achieve superb ratings in internal and external audits for compliance, accuracy, and timeliness.

Our back-office Enrollment/COB teams are an integral component of our organization’s Customer Service Excellence strategy. We partner closely with our Customer Services teams across our larger UPMC System to ensure our customers and patients have the best possible experience and regularly seek additional opportunities to enhance the experience further. A strong partnership with our Central Billing Office in 2018 resulted in several key operational workflow improvements that increased efficiencies, reduced costs, and ensure a positive customer and patient experience with their healthcare claim billing. Improvements such as these have enabled us to increase our COB Savings from $85.9M to $126.6M from 2017 to 2018.

At the cornerstone of our strategy is our unique Enrollment Concierge role and our back-office chat/help desk support lines. Concierges serve a dual purpose of supporting both Customer Services and Enrollment/COB teams. They support front line inbound and outbound calls and our back-office Enrollment/COB work; their time is split based on business needs. Our Concierges are strategically staffed to support peak call volumes in Customer Service to improve the customer experience while minimizing operational costs. Their unique perspective allows our teams to work together fluidly, enabling us to side step traditional gaps in cross-team workflows. This position, a promotional opportunity for existing team customers, is often the first to recognize both procedural/training opportunities among both teams.

In 2017, our Enrollment and COB teams leveraged existing telephony technology and implemented live Chat and Help Desk lines, called Resource Units, for Customer Services team customers to connect with live back office support. This program was tremendously successful and continues to be a great success today: over 18,000 chats and 13,000 live calls were taken in the back office in 2018. After launching these lines, our focus in 2018 has been to identify drivers to these lines and focus on process improvement on activities in the back office that impact the Customer or CSR experience. Among some teams, the support has developed into live, in person support as part of the Customer Enrollment Alliance (MEA) program, designed to increase partnership and camaraderie between the front and back offices.

Process Improvements/Outcomes:

-Consistent reduction in inquiries to the back office across Enrollment and COB; ranging from 31%-70% reductions to individual back office teams

-Implemented 30-minute billing report to allow close to real time eligibility updates for Marketplace and CHIP customers, ensuring more immediate access to coverage

-Implemented a direct line for Customers to contact our Enrollment Team to resolve an Enrollment case (HICS) initiated on the Federally-facilitated Marketplace (FFM); resulting in improved service and resolution time (TAT improved by 1 business day)

-Integration of an annual Medicare Enrollment notice into the annual marketing letter, ensuring personalization and reducing mailing costs and inbound calls

-New proactive processing of customers who are eligible for more than one UPMC policy, ensuring a positive claims experience and reducing rework significantly (est. cost savings $1.2M)

-Increased back off support in driving new product implementations to ease the burden on Customer Services, ensuring a positive customer experience, and support overall organizational excellence