Business Process Guidance A GPS for Health Insurers Customer Service Organizations

Transcription

1 Business Process Guidance A GPS for Health Insurers Customer Service Organizations Panviva s Business Process Guidance (BPG) system is a GPS for the desktop, guiding Customer Service Representatives step-by-step in real-time, through processes and policies across multiple systems, departments and product lines. It s the new low-cost, low-risk way to drive customer satisfaction and compliance while driving down costs aggressively.

2 2 Business Process Guidance: A GPS for Health Insurers Customer Service Organizations Business Process Guidance A GPS for Health Insurers Customer Service Organizations It s the new low-cost, low-risk way to improve customer satisfaction and compliance adherence while driving down costs aggressively. Introduction In every health insurer s call center customer service representatives (CSRs) struggle with a multitude of complex business process and operational concerns while trying to conduct daily business. Intense focus on profitability motivates health insurance executives to look for new ways to lower costs and improve customer service. In the past, health insurers were forced to rely on customer relationship management (CRM) systems and business process management (BPM) deployments to drive customer service functions. Today, CSRs toggle between multiple systems to find information relating to the live-call or call-on-hold, thereby increasing average handling times that lead to costly help desk staff interventions and call backs. All this frustrates the customer, who ultimately pays for this added cost. Business Process Guidance (BPG) systems are a new and innovative way to address this Just like a car s GPS, a BPG system determines at what point a user is in a process in terms of open screens and applications, and provides step-by-step directions through complicated procedures, advising the user about policies and best practices along the way. array of challenges. By utilizing a BPG system, health insurers can dramatically reduce call transfers and escalations by over 75%, improve first call resolutions (FCR) by more than 20%, and decrease failed customer interactions by nearly 30%. BPG is a desktop solution that CSRs can use to tie information from disparate systems, giving them a single easy-to-use view into the product information they need. With step-bystep guidance through policies and procedures, BPG can guide them to the answers they need quickly and effectively with dynamic search capabilities. A year after implementing a BPG system, Australia s largest private health insurer, Medibank, dramatically decreased the volume of calls to internal help desks by more than half, from 20,000 to between 6,000 and 9,000 calls per month. BPG enabled customer service agents to take on new products faster, improve morale, and reduce the rework resulting from mishandled calls by 13%. In addition, they were able to save significant sums due to fewer disputed claim payments. The success of BPG in the contact center spurred the company to implement another BPG project this one for back-office staff. Earlier this year, the benchmarking company, Global Review recognized this same health

3 Business Process Guidance: A GPS for Health Insurers Customer Service Organizations 3 insurer as one of the top-performing contact center companies for customer service. The State of Customer Service Customer service is a difficult job. The Forum Corporation, a global management consulting firm located in Boston, recently conducted research that indicated 45% of customers stated they switched to another company because the attention they received was poor in quality. Contact center CSRs that use ERP and CRM systems today deal with too much complexity - too many facts and too many policies and procedures, all changing at an ever-increasing rate. CSRs must often comb through mounds of information in disparate systems for the most current procedure while policyholders impatiently wait on hold for answers. This makes consistency almost impossible; multiple employees are challenged to provide the same answer to the same question each time it is posed. Insufficient CSR training, high wait times, poor first call resolution rates and high call-abandonment rates result in a poor total service factor. Adding insult to injury, the inefficient and complicated procedures that often lead to poor customer service actually cost more. Medibank, dramatically decreased the volume of calls to internal help desks by more than half, from 20,000 to between 6,000 and 9,000 calls per month. A significant business challenge remains: How can managers get their staff to remember how to do the right thing, every time? Those who want enterprise-wide adherence to procedures and policies cannot continue to rely on time-intensive and costly training as the sole means to ensure all staff members are knowledgeable and well-informed. Things change too fast for that. And consider how CSRs are forced to multi-task throughout each day. They must: navigate several applications at a time, interpret what they read, respond to specific questions, contend with the pressure of performance measurement, adhere to company standards, maintain a patient and friendly telephone manner. Based upon managing the demands of all these activities, it is easy for CSRs to stumble, hesitate, or make the wrong decisions that waste precious time and drive up the cost of doing business.

4 4 Business Process Guidance: A GPS for Health Insurers Customer Service Organizations BUSINESS PROCESS GUIDANCE (BPG) SYSTEMS Guiding the way, step-by-step Business process guidance helps CSRs handle calls in the most efficient and accurate way possible by providing step-by-step assistance throughout the call. BPG assistance is always relevant to a CSR s role, the type of inquiry, and the applications in use on a CSR s desktop. A BPG system incorporates many innovative principles and practices associated with state-of-the-art knowledge management systems. A BPG system is unique in the way specific steps and information are displayed for the CSR who is working to resolve the call, while navigating multiple desktop applications in real-time. Using a state-of-the-art solution, such as BPG, companies can ensure that the same information is provided by each CSR as they respond to similar questions. Managers can rest easy knowing that consistency, policy adherence and resolution are all addressed in every call. Not only will CSRs be confident with the answers they provide, but their knowledge will resonate with members improving customer service levels and optimizing retention levels. Health insurers can reduce dissatisfaction and expensive employee turnover while aggressively driving down costs. BPG pays for itself in well under a year, making it the contact center technology of choice in this tough economic climate. Benefits of BPG According to the Bureau of Labor Statistics, employment of CSRs is expected to increase 25% from 2006 to 2016, much faster than the 45% of customers stated they switched to another company because the attention they received was poor in quality. average for other occupations. To make matters worse, statistics stipulate that it takes approximately nine months to train a CSR to understand fully what they need to know to do their jobs. With high turnover rates for these positions, this represents a serious problem, especially as many consumer complaints state that CSRs do not have the skill, expertise or training to resolve customer problems. There is a solution. The benefits of BPG include vastly improved first call resolution (FCR) rates, a dramatic decrease in training required for CSRs, lower operational costs driven by reduced need for help desk staffing, and reduced average handling times. Improving First Call Resolution According to a 2006 Hart study, when companies seek to increase customer service levels, the need to improve first call resolution (FCR) is ranked as the highest priority. The study further details that a lack of FCR results in operating cost increases of 30% due to repeat calls, escalation inquiries, and customer dissatisfaction. With compounded issues of multiple systems, new employees and constantly changing policies, insurers are faced with a daunting task to improve FCR rates. BPG helps organizations improve FCR rates by more than 20%. It ensures that CSRs have the most up-to-date information in an easily accessible and consistent format, available at

5 Business Process Guidance: A GPS for Health Insurers Customer Service Organizations 5 their fingertips. They no longer struggle with multiple applications to find the information they need. They can answer questions rapidly, the first time, every time. Success like this not only develops customer satisfaction, but also delivers significant improvement to the bottom line. Making Training Quicker and Easier In a pilot study, a leading health insurer in the U.S. discovered that the time necessary to get CSRs to achieve proficiency could be reduced from six (6) months to one (1) month by using BPG. Additionally, the company was able to cut new hire training needs and reduce the refresher training time required for existing employees from 10 days to eight days per CSR a 20% cost reduction. BPG changes the nature of training. CSRs are no longer required to memorize facts and the location of information in multiple systems. With BPG, no matter where the information lives, CSRs are guided to the answers they need. No matter how often the policies, procedures, and product information change, CSRs can access seamlessly all updates in real-time, with no more fumbling through training manuals and reams of information. Similar to when drivers use a GPS system and no longer need to study routes and memorize maps, a BPG system simply needs to know what CSRs are looking for and helps them find it at real-time speed. BPG cuts training times by almost half while delivering top-quality results. This expedited process dramatically improves the timely BPG cuts training times by almost half while delivering topquality results. knowledge of staff while reducing the burden of call escalation and limiting the need for large internal help desk support. That dramatically drives down costs while improving customer satisfaction. BPG provides CSRs clear and accurate direction, guiding them to the information they need step-by-step. Because CSRs now have all of the information they need in one consolidated view, they are empowered to answer questions quickly and more effectively. No longer will they get frustrated by their inability to answer the questions that made them rely heavily on help desk support. When CSRs have the correct data available in real-time there is less demand on the help desk. This allows call centers to significantly reduce internal support costs Reduced average handling times By offering the best tools to accommodate CSRs, companies can train them rapidly while ensuring they follow policy and procedure guidelines to answer the right question the right way, consistently. CSRs can improve call handling times with one view into the most up-to-date information. No longer will members have to wait on hold while CSRs dig through multiple locations looking for the right answer. Call times can be shortened, giving CSRs the ability to move on to the next customer inquiry quickly, thereby increasing their overall call volume. Overall, enterprises can decrease costs through faster and more efficient training, reduced support team reliance and lower resolution call times.

6 6 Business Process Guidance: A GPS for Health Insurers Customer Service Organizations SupportPoint The Health Insurance Industry s Leading Business Process Guidance (BPG) System SupportPoint guides contact center and back office personnel step-by-step through procedures, policies and product information, shepherding them through business processes the right way, first time, every time. Support Point is a proven enterprise BPG system that provides all CSRs with a viewer on their desktop. This viewer, available via a web or client application, accesses a server that subject matter experts keep updated with the latest versions of role-relevant procedures, policies and product information. SupportPoint Viewer recognizes at what point users are in a process (i.e. which application screens they have open), assesses their role and experience level, and provides real-time guidance with procedures, policies and product knowledge. SupportPoint Author provides subject matter experts with a powerful, yet non-technical, authoring environment that enforces strict styles and standards on content for a highly consistent presentation to CSRs. SupportPoint Application Server provides enterprise-grade content management and reporting capabilities including versioning, role management, multiple language support and translation, usage analytics and audit trails.

7 Business Process Guidance: A GPS for Health Insurers Customer Service Organizations 7 Ease of Deployment SupportPoint can be hosted either by Panviva or installed at a client site. Typically, installations take approximately one week. Most upfront work for deploying SupportPoint focuses on the content required to document specific policies and procedures. BPG can be implemented with flexible license models, such as perpetual and software as a service (SaaS). This state-of-the-art application can integrate with most core applications and needs only a server to run. SupportPoint is not intended to replace CRM, BPM or ERP applications, but rather to enhance, support, and manage applications and information. BPG, as delivered by SupportPoint, maximizes the value extracted from these systems and increases ROI from strategic investments. It helps CSRs navigate through the complexity of multiple desktop applications, weaving them virtually into a single system with regard to the company s most important procedures and policies. While BPM systems can be seen as autopilots, BPG is more like a GPS system. BPG handles many things not covered by BPM systems, adding to the nimbleness of the enterprise and making very quick implementation of procedures and policies possible so that companies can respond rapidly to changing market conditions. BPG Delivers Proven Results Panviva has more than 100,000 Viewer users, and has helped leading health insurers achieve exceptional returns on investment (ROI) and improve the quality of CSR interactions with customers.

8 8 Business Process Guidance: A GPS for Health Insurers Customer Service Organizations CASE STUDY Medibank Private, Leading Australian Health Insurer Australia s largest national private health insurer, Medibank Private, representing about 30% of the national private health insurance market, has implemented BPG. The company has more than 100 retail centers in every state and territory across Australia and boasts more than three million members. The Problem This leading health insurer experienced a sustained drop in staff satisfaction and retention levels within its contact centers. The company relied on a relatively ad-hoc knowledge management system, making it difficult for customer service agents to provide accurate and timely insurance information to customers. As happens in so many companies, Medibank Private s intranet contained 1,400 files and had become a one-way dumping ground for corporate information. Although all the information was there, little was readily accessible in a format that agents could use in real-time. This caused problems, especially when customers waited for information. Agents often gave customers conflicting information. They needed a solution to help reduce average call handling times and improve first call resolution. The Solution This knowledge management solution has changed the company for the better, because front-line workers are under less stress and provide better services to members. The company recognized that by using BPG, they could not only reduce initial training costs by 50%, but they could also improve staff retention through better on-the-job support, resulting in an estimated savings of several hundred thousand dollars annually. It was evident that an additional million dollars per year savings could be achieved by reducing call handling time by 10%. George Savvides The company selected the Medibank Private Panviva SupportPoint BPG system to ensure that call center CSRs and retail outlet staff had the right information at their fingertips, fast. After a 13 week pilot program, average call-handling times were reduced and first call resolution improved dramatically (help desk escalations reduced by 75%).

9 Business Process Guidance: A GPS for Health Insurers Customer Service Organizations 9 CASE STUDY A Leading National Pharmacy Benefits Provider A leading national pharmacy benefits provider for government and commercial health plans to more than 63,000 network pharmacies nationwide is conducting a pilot implementation of Panviva s SupportPoint. The Problem This national provider wants a solution to improve operational efficiencies and CSR satisfaction, to reduce reliance on team leads and subject matter experts, to improve first call resolution without escalation, and to reduce average handling time while improving CSR quality ratings through consistency and accuracy of information given to beneficiaries. They want to do all this and aggressively reduce costs at the same time. The Solution SupportPoint was identified as the system that could store and deliver process and product guidance to CSRs during live member calls for the Medicare Part D Program. The provider identified SupportPoint BPG as the system that could store and deliver process and product guidance to CSRs during live member calls for the Medicare Part D Program. The goal was to achieve highly consistent and cost-effective customer service and to implement a pilot project that proved results. The results established that in a full deployment, average call handling time (AHT) could be decreased, providing a savings of $537,000 annually. Results also demonstrated that the ease of BPG use would allow less domainexperienced new hires to handle calls, reducing CSR labor rates by $301,000 a year and decreasing help desk escalations by 70%. Total savings were calculated to be in excess of $ 1 million per year, resulting in a projected payback of approximately 3.4 months.

10 10 Business Process Guidance: A GPS for Health Insurers Customer Service Organizations CONCLUSION Panviva s SupportPoint - Business Process Guidance (BPG) system, is not only a pioneer in policy adherence systems, but also an experienced leader that delivers the results required to create a competitive cost and service advantage. SupportPoint, a proven system for health insurers, has demonstrated incredible efficiencies, reduced operational costs, improved CSR quality and enhanced overall customer satisfaction. down costs. A new solution to an old problem, but with proven results and the confidence of quick pay-back and low SupportPoint s benefits include: Short implementation timeframe that delivers payback in months not years Simple low-risk implementation Improved first-call resolution resulting in fewer escalations and callbacks Far more accurate, up-to-date and consistent information communicated by CSRs Improved governance through adherence to processes Faster time-to-desk and time-tocompetence Shorter and fewer customer holds. Organizations with complex processes and systems use SupportPoint to offer CSRs selfservice procedures, policies and product information that delivers the right knowledge at the moment-of-need, in real-time. SupportPoint delivers structured, up-to-date, and personalized content that gives users rapid access to just the information they need to complete their task correctly. Globally, more than 100,000 users rely on SupportPoint. Call center users reduce processing errors, strengthen compliance, and increase customer service levels while driving

11 Business Process Guidance: A GPS for Health Insurers Customer Service Organizations 11 Business Process Guidance - guiding CSRs step-by-step through processes that cross multiple insurance enterprise applications.

12 12 Business Process Guidance: A GPS for Health Insurers Customer Service Organizations Contact Us T o l e a r n m o r e a b o u t h o w S u p p o r t P o i n t s B u s i n e s s P r o c e s s G u i d a n c e s y s t e m c a n d e l i v e r r e s u l t s t o y o u r o r g a n i z a t i o n, v i s i t : Or c o n t a c t u s a t : United States Panviva Inc. 15 New England Executive Park Burlington, MA Phone: Australia Panviva Pty Ltd Level 1, 683 Burke Road Camberwell, VIC 3124 Phone: +61 (0) Gartner does not endorse any vendor, product or service depicted in its research publications, and does not advise technology users to select only those vendors with the highest ratings. Gartner research publications consist of the opinions of Gartner's research organization and should not be construed as statements of fact. Gartner disclaims all warranties, expressed or implied, with respect to this research, including any warranties of merchantability or fitness for a particular purpose.