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UPMC Health Plan - Enrollment & COB Services

Gold Stevie Award Winner 2018, Click to Enter The 2019 Stevie Awards for Sales and Customer Service

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: UPMC Health Plan Enrollment & COB Services: Back Office Team of the Year

Tell the story about what this nominated team achieved since the beginning of July 2016 (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 members are enrolled timely and they 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 enrollment timeliness and accuracy rates are consistently excellent; our Medicare Enrollment team processed over 30,000 enrollment applications in 2017 and achieved a 99.7% timeliness rate.

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 to ensure our members have the best possible experience and regularly seek additional opportunities to enhance the experience further.

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 Member 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. 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 members, is often the first to recognize both procedural/training opportunities among both teams.

Recognizing the need for Member Services team members to connect directly with experts in the back office during live calls, without placing the member on hold, we leveraged existing telephony technology and implemented an option for Member Services to chat with our Enrollment/COB experts in the back office (all team members, not just Concierges!). Since January 1, 2017, the Enrollment and COB team members have received over 27,000 live chats, with an 88.7% service level). Enrollment/COB leaders manage over 60 different specialized skills to ensure the Member Service Representative reaches the right Enrollment/COB expert the first time.

At UPMC, we regularly solicit feedback from team members to identify additional opportunities. During a cross departmental focus group, we heard from both front line and back office team members they would like the option to speak directly to an Enrollment/COB expert to resolve more complicated issues, rather than just chat. The passion to serve and support an outstanding member experience was truly evident with this recommendation! In late April 2017, we launched live Resource Unit support for our Member Services team members. Since that time, the Resource Unit has received over 2,000 calls at an 87.5% service level. Our back-office team members truly recognize the importance of helping our partners in Member Services in the exact moment they need help!

Additional Process Improvements/Outcomes

-Implemented near-real time process to update eligibility after late payments, to ensure immediate access to pharmacy and medical services (previously batched/updated overnight)
-To retain members and ensure they understood their new limited network plan, Enrollment conducted outreach calls upon processing the enrollment application (649 outreaches in 7 weeks, with an 81% reach rate)
-Implemented personal outreach by an Enrollment expert to discuss the Medicare Late Enrollment Penalty at the onset of the investigation to explain the process to members and attempt to gather information to help them avoid the penalty. Since October 2017, over 1,300 outbound calls have been made, and 85% of those we reached were resolved the same day.
-Implemented “Tip of the Day” for Marketplace and Commercial teams, sharing over 160 daily tips to Member Services since April 2017. These tips are store in our Member Services knowledge tool and have had over 5,600 hits.
-Reduced CHIP Enrollment chats by 29% by recognizing payments as a top Enrollment chat topic and implementing and training a new CHIP payment tip sheet in July 2017.