Delivering superior service Featured

7:00pm EDT February 24, 2008

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