Company: UPMC Health Plan, Pittsburgh, PA
Company Description: UPMC Health Plan, headquartered in Pittsburgh, Pennsylvania, is owned by the University of Pittsburgh Medical Center (UPMC), a world-renowned health care provider. An integrated health care delivery system, we are committed to providing our members better health, more financial security, and peace of mind. Our provider network includes 140 hospitals and 29,000+ physicians, serving 4M Members.
Nomination Category: Customer Service Department Categories
Nomination Sub Category: Customer Service Department of the Year – Healthcare, Pharmaceuticals, and Related Industries
 Nomination Title: UPMC Health Plan
- 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
- 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 department: its history and past performance (up to 200 words):
Total 200 words used.
UPMC Health Plan, headquartered in Pittsburgh, Pennsylvania is owned by the University of Pittsburgh Medical Center (UPMC), a world-renowned health care provider. Our Member Services Concierge team of 369 delivers World Class experiences to 4M+ members, answering 3.3M inbound calls, 62K chats, 22K web messages and conducting 600K outreach calls annually. By focusing on people, processes, and technology, we enhance operations to ensure member satisfaction and growth. Our Healthcare Concierge Team offers service beyond industry standards, taking pride ensuring our members are cared for, prioritizing First Call Resolution (FCR) and managing a robust service recovery program to guarantee issues are resolved.
Our commitment to excellence is unwavering, and our dedication to process improvements based on customer feedback is the driving force. We are constantly improving to enhance efficiencies and deliver exceptional experiences. This is only possible when you have a Customer Service Department (Member Services) that is completely committed with the highest level of passion for serving our members and our team.
We have earned the highest in Member Satisfaction with JD Power for both our Commercial and Medicare products. This doesn’t happen by accident. This happens with the entire village/city we have working hard on this every day
- Outline the department's achievements since July 1 2022 that you wish to bring to the judges' attention (up to 250 words):
Total 239 words used.
Our structure includes mighty support teams, ensuring outstanding experiences for members and employees:
- Member Satisfaction: After Call Survey offered on every interaction; 30 Day After Call Survey sent via email. Automated process for unhappy members; routed to a Satisfaction Analyst identifying root cause, finding a solution, and reaching out to the member. Service Recovery identifies pain points, and the team works across the organization to solve issues going forward.
- Service Excellence: Robust recruitment/onboarding programs, ensuring our environment is caring and welcoming. Drives employee engagement initiatives including socialization, mental health and well-being, teamwork, rewards, and recognition.
- Training: New Hire training, 12 weeks long, includes on-the-job training. Trainers are invested in the success, providing weekly reports of the class. Ongoing training ensures we build skills and knowledge; 36.08% of the 2024 training was developmental, 14.21% in 2023. Implemented a new Learning Management System for efficient and effective training.
- Coaching: Coaching sessions are biweekly, including listening to 2 calls/chats, reviewing member feedback, and statistical performance. 83% coaching sessions achieved in 2023, 91% in 2024. Created a coaching system, Beyond, measuring and tracking the process and achievements.
Speech Analytics: Quality scoring on 100% of calls, monitoring call avoidance, identifying trends/issues, repeat caller identification, and then works to resolve the abrasion going forward.
Workforce Management (WFM): Deployed Concierge and Leadership dashboards tracking performance. Implemented WFM tool for scheduling and adherence. Manages all technical issues through Azure with 3219 tickets completed in 2024.
- 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 249 words used.
The Best Customer Service Department does not just be nice to customers and solve the issue at hand. It is proactively solving issues for all customers going forward, removing points of abrasion, ensuring the issue is solved and next best action is taken, all reducing customer effort (98.2%). The attached Power Point outlines our success and demonstrates why UPMC Health Plan should be considered for this award.
Slides 1-6 outline who we are and how we are integral in the success of our company. Slides 7-8 share Contact Center Successes achieved in 2024.
Slides 9-11 demonstrate how our Member Satisfaction team is ensuring high Customer Satisfaction and how impactful the Service Recovery process is.
Slides 12-22 share the accomplishments of our Service Excellence team, responsible for recruitment & onboarding, building tools for team success, and engagement activities, including providing resources and support for Mental Health for our team.
Slides 23-29 elaborates how the Training & Coaching teams support the concierge team to provide outstanding experiences for our members.
Slides 30-33 exhibit the Speech Analytics team and profound impact they have had in removing points of abrasion while monitoring the team.
Slides 34-38 reveal some of the outstanding achievements of our WFM team. All of the teams have driven the financial results, and this team brings it all home.
Slides 39-42 are proof that what we are doing is working. Customer Service is how we differentiate and sell our business with a billboard and a commercial on slide 41.
- 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 249 words used.
A structured approach to Customer and Employee Experience is driving strong results. Employee turnover is 11.31%, 20.69% for new hires, well below the industry average of 30%-45 and resulting in $1.25M in savings compared to 2022’s turnover rate of 22.89%. Engagement rates are impressive, with 95% participation and 81% Engagement score, 10 percentage points higher than the rest of UPMC’s 106K employees.
Through training and coaching, our team has achieved a First Call Resolution (FCR) rate of 95.2% for 2024, well above the industry average of 70-75% (nobelbiz.com). Our satisfaction rate is 96%, exceeding the 90% benchmark of top-performing centers. Service Recovery process identifies areas for improvement, with 95.8% of unresolved member issues thoroughly researched, driving operational solutions. JD Power ranks our "People – Call Center Representative" as #1, 66 points above the regional average.
Speech Analytics uncovers valuable member experience insights. Sharing these insights with other teams and vendors, we’ve implemented solutions that led to a 33.74% reduction in call volume for our Commercial products, allowing us to decrease our workforce by 107 team members.
Our WFM Team manages our contact volume, achieving 82% Service Level (% within 30 seconds) and a 24 Second ASA. Implementation of our WFM Tool increased Occupancy to 85.60%, above industry average (Call Centre Helper) of 83.3%.
We earned Highest in Member Satisfaction for Commercial and Medicare (for the past 2 years) in the Pennsylvania region in JD Power Syndicated Health Plan Study.
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