Healthcare Service Case Study

Challenge

A U.S. health insurer, with a majority of its members in the over-65 market, was dissatisfied with the performance of its India-based call center. In addition to cultural and communications issues, the offshore company had failed to comply on a consistent basis with marketing regulations mandated by the Centers for Medicare and Medicaid Services (CMS). The health plan sought to move its contact center operations to a domestic provider in order to raise member service levels and be in compliance with CMS regulations.

Solution

ConnextionsHealth established a U.S. contact center staffed with nearly 100 highly trained customer service agents and additional licensed insurance agents to enroll new members. Member service was provided in both English and Spanish.

Results

ConnextionsHealth’s agents have consistently provided customer service levels that exceed the client’s requirements. Additionally, the client now operates in full compliance of CMS regulations, reducing the risk of fines, damage to its reputation, and loss of business. ConnextionsHealth agents regularly exceed the 80 percent service level goal, and the plan’s quality assurance results far exceed all existing standards.