Superior service

In the health insurance industry, the customer experience is an essential component to the long-term success or failure of the company. And since health insurance is a highly competitive market, many health insurance companies are paying increased attention to the things they can do to retain customers by making every interaction with the company as hassle-free and positive as possible.

“Successful businesses create customer loyalty by delivering customer service that is differentiated and highly relevant to the needs of the customer,” says Nancy Markle, vice president of client services at SummaCare, Inc. “They know their customers and put them at the center of their businesses in regard to day-to-day operations, decision-making and strategic planning.”

Smart Business spoke to Markle about the components of a good customer service team, as well as things employers should consider in regard to customer service when selecting a health insurance company.

Why is delivering outstanding customer service so important?

Delivering outstanding customer service is especially critical to a health insurance company that is focused on its members’ health and wellness. Having a strong, competent customer service team is essential to not only the members’ experience when dealing with the company, but also the opinion the members will formulate based upon their interactions.

What are the components of a strong customer service team?

A strong customer service team is comprised of individuals dedicated to delivering consistently high levels of customer service based on the member’s expectations. This team puts the member at the center of the interaction and anticipates the member’s needs. A strong customer service team focuses less on the short-term transactions and more on the end-to-end experience that creates trust and loyalty.

Customer service representatives should be empowered to make decisions to serve the members. Since most people who contact their health insurance company’s customer service department have medical benefit related questions or other inquiries, the customer service representative must be able to triage the nature of the call. They need to know how to ensure that the members’ needs are met to their satisfaction.

Customer service representatives should also be able to educate members on the tools and information available to them. They should be able to communicate benefit information, health and wellness offerings, disease management programs and self-management tools.

Most importantly, customer service representatives need to be able to empathize and make a personal connection with the member. They should be able to recognize the needs of the member, explain the options they have and validate their feelings. This helps build the trust and a relationship with the member that is essential to a positive and beneficial member experience.

What should employers consider with regard to customer service when selecting a health insurance company and how do they know if the company is doing an excellent job?

Employers should select a health insurance company that puts the members first and focuses on the satisfaction and experience a member has with the company. They should select a health insurance company that educates the members on how to best utilize their health care benefits, thus empowering the member to make informed health care decisions.

Employers can learn more about the customer service offered by a health insurance company by examining satisfaction scores, national rankings and accreditation status by health care accrediting bodies. Employers can request member retention rates and member turnover from the health insurance company.

Another way an employer can gauge if a health insurance company is delivering excellent customer service is by gathering feedback from employees. They should ask employees how their experience(s) with customer service has been and if they feel issues were handled accurately, with courtesy, effectively and promptly. If employees are satisfied, then the health insurance company has met their expectations.

A health insurance company that delivers excellent customer service will also collaborate with an employer to develop health and wellness programs targeted at keeping employees healthy. Since the insurance company has the group’s claim history available, they can often identify areas where a tailored health and wellness program could benefit the employee population.

Are performance guarantees acceptable?

Performance guarantees are not only acceptable, they are encouraged. They develop a level of accountability for the health insurance company and are often an incentive to deliver high-quality service.