For a health care benefits company,
customer service representatives
serve as the important first line of contact for customers. These professionals work directly with members,
employers and health care professionals to help them better understand the
company’s products and services and to
help with timely, accurate payment of
their claims — while providing a human
connection at those times when it is
needed most.
Traditional customer service outlets
continue to play an important role in
managing customer and member satisfaction levels. However, the idea that
individuals should have greater control
over the decisions affecting their health
care has prompted some insurers to
take a closer look at what it means to
provide good customer service.
“Consumerism is changing the way
insurers view customer service,” says
Bill Berenson, senior vice president of
Aetna’s Small and Middle Market
Business for the North Central Region.
“Once considered to be a phone call to
an insurer’s customer service call center, today ‘service’ can easily be applied
to the information, tools and cost-savings solutions that insurers offer their
members and customers.”
Smart Business spoke with Berenson
to learn what insurers are doing to stimulate customer and member satisfaction levels.
What are insurers doing to better serve
their members?
Many insurers now offer their members a self-service Web site where individuals can retrieve their personal
health benefits information, such as the
status of claims they have filed and
their Health Savings Account or
Flexible Spending Account balances.
These sites can also include resources,
such as physician directories, cost and quality comparison tools, and information on health and wellness programs.
It is imperative that the personal
health information stored on these sites
is completely secure. Laws, including
the Health Insurance Portability and
Accountability Act (HIPAA), govern
how the information on the sites can be
used, and insurers must make it easy
for members to find their privacy policy
and other information about site security. These are important aspects of customer service that can easily influence
a member’s view of the insurer.
What other offerings can be considered
good customer service?
Surprisingly, much of what is considered customer service takes place
behind the scenes. Most major insurers
now offer personal health records — a
powerful, interactive tool that provides
members with secure online access to
their personal health history, consisting of claims data and self-entered information. In some cases, these personal
health records are powered by technologies that continuously scan an
individual’s health and claims information against highly respected sources
of medical literature and can alert
members and doctors about possible
urgent situations and opportunities to
improve care.
This kind of data mining and integration is invaluable to members because
it allows them to become more
informed about their own health care
and actively participate in the health
care process, which often leads to better health outcomes.
Employers are customers, too. What are
insurers doing to better serve this group?
A select number of insurers have
developed self-service, Web-based tools
to make it easier for employers to
update and change member enrollment
information. These tools provide online
access to member eligibility information for medical, dental, pharmacy, and
life and disability coverage. They give
customers the ability to expedite online
member additions, terminations, life
event changes and selection of benefits.
In addition, these solutions improve
the accuracy of benefits selection,
increase the speed with which benefits
changes are made, eliminate the number of pending member enrollments
[because of incomplete information]
and increase the delivery speed of
member ID cards. All of this has a
direct, positive impact on customer and
member satisfaction levels.
BILL BERENSON is senior vice president of Aetna’s Small and Middle Market Business for the North Central Region. Reach him at
(312) 928-3323 or [email protected].
