The Thing About Healthcare Contact Centers

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Published:  May 5, 2021

Are all contact centers alike? It’s true that no matter which industry they serve, all centers are charged with maximizing productivity, agent engagement and customer service level while at the same time keeping costs to a minimum. They rely on technology to do this, primarily WFM systems to match staffing levels with anticipated call volumes and ACD systems to route incoming calls to agents best prepared to resolve the caller’s issue.

But behind the operational and financial efficiency challenges, there’s something even more important: Human callers expect a human experience! If this weren’t so fundamentally important, chat bots would have replaced human agents by now. And though it may seem counterintuitive, technology has a major role to play in helping centers deliver the empathetic, human experiences customers demand. This is true across all businesses, but perhaps nowhere more than healthcare.

Unique challenges

The need for a “human touch” is especially critical to healthcare centers because callers are grappling with complex financial and administrative issues that may also be related to questions of life and death.

Healthcare contact centers respond to a broad range of issues: from benefits (what’s covered?) to eligibility (am I covered?), claims (how much is covered?) and escalations (why was I not covered?). These issues are governed by specific rules, restrictions and requirements that vary across regulatory bodies and geographic locations. Needless to say, those rules also change regularly.

Medicare questions are subject to federal rules, for example, while Medicaid questions are governed by rules defined at the state level. A Mississippi-based healthcare contact center advocate (agent) would not be the ideal choice to resolve a Medicaid question for a caller in Delaware (in fact, the call would probably not be routed to the Mississippi center in the first place).

So the level of expertise required of healthcare center advocates may be higher—or at least more specific—than in other industries. That’s why it’s not uncommon to find licensed nurses, pharmacists and other caregivers taking customer calls in healthcare contact centers.

Additionally, consolidation among major health insurance providers has resulted in organizations with multiple technology systems; each partner may have its own ACD and WFM systems, which complicates the overall organization’s customer service operations.

A major role for tech

The challenge of multiple systems within the same organization can be overcome with a technology platform that integrates easily with standard contact center technologies. If the platform is also able to process time-sensitive data in real time and take prescriptive action based on actual center conditions, it will also make an invaluable contribution to overall center productivity.

The broad diversity of healthcare center issues and regulatory considerations means that training will be critical to success. Long days of classroom training for new advocates is giving way to targeted, Web-based sessions delivered at irregular intervals. An intelligent automation platform capable of tracking call volume, agent activity and other center activities can identify pockets of opportunity and deliver modular-based training sessions to advocates (who are most likely working remotely) when it’s most conducive to advocates as well as overall center operations.

A sometimes-overlooked aspect of effective technology is how intrusive it is (or isn’t). The complex nature of healthcare insurance issues means that calls often take longer to resolve than in other industries, and advocates really need to focus. In addition, the caller may also be emotionally distraught. An advocate juggling these demands who is also overwhelmed by administrative messages will have a more difficult time resolving the caller’s issue.

But a platform that allows center leaders to script precise responses to complex issues and deliver them to advocates’ computer screens in a timely fashion will help facilitate the flow of necessary information without stepping on the advocate’s efforts to resolve issues in a sensitive manner.

All in the service of empathy

The highest priority in a healthcare contact center is to resolve customer issues quickly, professionally and empathetically. Intelligent automation technology facilitates a center’s ability to deliver its profoundly human service by anticipating and executing all the vital but non-human aspects.