A Multi-Billion-Dollar Health Insurer’s Call Center Performance Improvement

A Multi-Billion-Dollar Health Insurer’s Call Center Performance Improvement

Our client for this engagement was the Southeast regional service center for a $16 billion medical and health insurance company. The insurer serves 2.5 million members through five business units and a wide variety of products. Every year, the 1,300 service representatives of the Southeast center handle more than 5 million calls and adjudicate 27 million claims. Throughout the company’s history, an emphasis on quality customer service has distinguished it from its competition.


Given an almost straight-line increase in expenses that was inversely proportional to a decrease in member satisfaction, there was an immediate need to improve service on both calls and transactions. Outsourcing, considered briefly, was discarded because of its inconsistency with the company’s values and service goals. The challenge left was threefold: improve customer satisfaction, keep employees motivated, and reduce expenses. With the situation worsening, the time frame for accomplishing these goals was short.

Current Environment

In the servicing area, experienced staff worked in a team-based, blended environment, and they were tasked with handling both transactions and phone calls. Calls were answered by all staff in both teams according to a rotating schedule. Between calls, staff were expected to do transaction work. Although staff had been trained in this wide range of work, stress levels were high as a result of the constant switching between backlogged service requests and the high volume of calls and abandoned calls—quality of service was mediocre due to the breadth of knowledge required. The lack of a routine to follow further exacerbated the situation.
Service metrics for the call center were rudimentary and based primarily upon the ASA (Average Speed of Answer) and Abandon rates. A quick solution was needed and with the limited systems resources available, reliance on technology had to be minimized.

Engagement Scope

The subject of this engagement was the handling of all calls and the processing of all service transactions. Call center staff, management, schedulers, statisticians, and transaction processors from the service area were included in the analysis and solution deployment. A 12-week time frame was established to analyze the situation, develop possible solutions and a set of recommendations, gain approval, and initiate the implementation of changes. To address the need, we adopted a focused approach. The Nolan team:

  • Performed an intense analysis of call and transaction volumes, patterns, types, reasons, and solutions
  • Reviewed workflow and work assignment
  • Developed detailed staff schedules and productivity standards and metrics
  • Performed in-depth, dynamic modeling of calls and tasks across existing staff by 15-minute intervals
  • Developed detailed work distribution schedules along with new performance metrics that better aligned staff with goals
  • Reallocated staff using intra-day resource planning and capacity tools
  • Effected changes in front-line managers’ behavior to incorporate intra-day resource management and full engagement with employees

Executive participation and support as well as the organization’s ability to adapt to change quickly were key.

Project Results

Implementation of these new staffing and capacity tools resulted in a redistribution of how work and calls are handled, specifically:

  • Employee multi-functionality was optimized in tiers, creating a 20% productivity increase
  • Annualized expenses were reduced by $10 million, the equivalent of 200 FTEs
  • Call volume dropped by 22% as follow-ups, callbacks, and corrections decreased
  • Customer satisfaction increased from 82% to 91% while membership rapidly grew
  • Clearer goals and schedules have resulted in employees who are more committed and less stressed
  • Managers have better control; today, they’re able to stay on top of service levels and quality

With no major investments or protracted projects, our client transformed itself into one of the top service providers in the marketplace. All it took was the implementation of a few key management tools along with a more effective work management process—the company continues to grow successfully while delivering market-leading service to its members.