Does the Open Enrollment Period Cripple Your Call Center?

2014-05-15-callcentre-data-missingWhile the onset of November may trigger holiday shopping for millions of people in the U.S., for health care insurers, it signals something even more stressful: Open Enrollment Period.

You know the drill. From November 1 through January 31, individuals can sign up for health insurance or change the plan they currently have. To help them make this important decision, they contact your call centers. And your agents are expected to know everything about your insurance plans, from eligibility to exclusions to plan options to pricing.

This narrow three-month period is clearly the “high season” for your call centers. The additional deadlines within this time frame also come into play, when you consider the different coverage start dates. New health plans take effect on the first of January, February or March, depending on when a person enrolls. These deadlines increase the stress of agents and callers alike.

The volume of calls coming into your company’s call center during this period is staggering. According to the Centers for Medicare & Medicaid Services, the cumulative call center volume in the federal marketplace totaled more than 14,569,000 for the last open enrollment period that ended January 31, 2016.

The third major challenge for your call center relates to all the changes in health insurance guidelines and regulations in the past year. Let’s face it: insurance premiums are going up double digits, which is reason alone for many people to want to find a new plan, especially if they need to spend less. At the same time, a switch could impact their choice of health care providers, who may or may not be part of a new insurer’s network. And many people will be forced to find new insurance, as several national companies, like United Healthcare and Aetna, have scaled back or bailed out of the Affordable Care Act, due to financial woes. Your agents have to know all of these regulations and potential changes in health care plans and be able to reference them appropriately for every caller. That’s pretty demanding.

How well call centers deal with these millions of calls during open enrollment is not only a function of your agents’ training and skills, but also of the real-time availability of accurate product information.

Callers expect these customer service professionals to have everything at their fingertips at the very time they call. Your agents are there to provide “moment-of-need” guidance. People need help understanding your insurance options. It’s very personal, and it’s very confusing. And they want this help in a matter of a few minutes during one (and hopefully only one) telephone call.

What resources do you give your call centers so that they can be successful during open enrollment? A priority is surely the obvious – your product information.

Agents need instant access to all of your insurance plans in real-time, and this information needs to be centralized and context-based. Such a data repository should be current and comprehensive, and have deep search capability. Ideally, it is based on logic, which allows agents to answer queries quickly and in ways that are relevant to the individual’s needs.

This automated workplace tool will empower your call center employees. Agents will increase their rate of first call resolution while decreasing the average handling time of their calls. They’ll be better equipped to provide the information and guidance expected of them to the millions of callers during this three-month open enrollment period, and well beyond.

Stephen Pappas

With more than 20 years experience in enterprise software sales and operations, Stephen Pappas manages all aspects of Panviva’s North American operations. He previously served as a Director of International Sales with Harte-Hanks Trillium Software, where he took their enterprise data management offering to 54 countries. Other roles have included Executive Vice President of a SaaS software start-up and Director of Sales and Business Development at PageFlex.

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