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Top 5 Health Insurer

Driving Value Through Better Contact Center Experiences

What if... improving contact center experiences could enhance customer and agent satisfaction and retention?

Our client, one of the largest health insurers in the United States, is a healthcare insurance, innovation, and pharmaceutical company and provider. Its mission is to help people achieve lifelong wellbeing.

A man with a pill organizer talking on the phone and looking at a computer.

Contracting Out the Consumer Experience 

A contact center experience can make or break member satisfaction and retention.

Our client needed to improve consumer experience scores and believed this could be accomplished by assessing contact center agent knowledge. Leadership especially wanted to understand this knowledge across the full contact center ecosystem, including third-party business process outsourcing (BPO) partners, which accounted for approximately 80% of the insurer’s call volume.

We set out to identify actionable ways the payor could drive greater operational value through its contact center.

Understanding the  Competitive Environment 

Contact center training groups offer varying types and cadences of agent learning assessments. Subjective methods rely primarily on trainer observations during the training process, whereas a more objective approach includes scenario-based assessments and feedback loops to consistently measure comprehension across a variety of skills.

We began our work with a comprehensive competitive analysis gathered through first-party and industry research, which helped our client understand how its knowledge measurement efforts rank in comparison with other leading organizations.

A woman talking on her cellphone and looking at a prescription medicine bottle.

Assessing Insights and Experiences Through Workshops 

Gathering all of the payor’s key stakeholders in a room at one time wasn’t feasible, so we hosted a series of events to gather insights from across the organization.

We conducted 17 workshops and interview sessions and captured critical input from more than 50 individuals across seven business groups that oversaw learning, contact center operations, business intelligence, vendor operations and contracting.

The workshops were facilitated by subject matter experts with specific areas of domain expertise, including:

  • Healthcare Member Experience
  • Contact Center Operations
  • Training and Assessment
  • Our management consulting expert served as “mission control” throughout the process to ensure we were engaging the right stakeholders, tying proposals and changes back to business value, and communicating that value to the client to ensure ongoing success, even after our work was done.

What Gets Measured Gets Done, Right?

Over the years, the payor gathered numerous data points but had never built a full view of its tracked KPIs. We mapped how its metrics do (and don’t) relate to one another and highlighted inconsistencies in what the payor measures versus what is measured and prioritized by its third-party contact center BPOs.

Next, we identified three core knowledge areas that would empower contact center agents to be true brand advocates and, importantly, identified the KPIs and processes that would solidify agents’ mastery of those knowledge areas.

An older man looking at some sticky notes on a clear dry-erase board.

Understanding Where to Begin

Our workshops, interviews, and metrics assessments identified multiple areas for potential growth. Our client needed to know where to focus first.

We leveraged our proprietary Prioritization Tool to help the payor work through decision making in a methodical, strategic manner.

We identified and presented five priority recommendations that would enable the client to make decisions with confidence and move into implementation with team alignment and clarity.

Five Recommendations for Change

After identifying five priority areas with high business value, we dug even deeper and supported each with:

  • Key insights
  • Recommendations detailing target outcomes, scope, and considerations
  • Measure(s) of success
  • Milestone plan
  • Quote from a stakeholder whose input informed the insight
  • A ranking for how the recommendation would benefit the client

This catalog of ideas equipped the client with actionable guidance, helping the payor to confidently change how metrics, training, and processes are approached for call center enablement.


A young man seated at a computer talking on a headset.

Helping to Deliver On the Brand Promise

Our recommendations reimagined how the organization measures success using a training mastery score – a leading indicator of contact center advocates’ overall performance, confidence, and knowledge. The primary goal of the score is to improve the member experience, but it can also be tracked to identify possible correlations to agent attrition.

The training mastery score moves beyond screens and the mechanical ways a process is explained. It deploys empathy and promotes behaviors that support healthcare consumers who may be requesting support while in pain or a heightened emotional state.

We drove a fundamental change in the way the business thinks about its third-party contact center partners, helping them realize it isn’t just an operational expense, but rather a business driver and, when done right, a vital advocate and leader in delivering on the brand’s promise of better care experiences.

We continue to work with our call center partners to more closely replicate the experience delivered by our employed agents through enhanced training. We’re also focused on service level agreements aimed at improving the quality of the sales experience and ultimately the customer satisfaction and retention. As part of this work, we have developed new computer-based training modules for our call center agents that focus on behaviors linked to customer complaints. While still early, we are pleased to have seen a decrease in complaints to CMS year over year. Chief Executive Officer, Top 5 Health Insurer

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