A South African call centre solution is saving a US medical insurance company time and money while boosting service levels

The insurance company's clients are experiencing up to a 30% reduction in call and hold times and a reduction in call errors.
In addition, the company has been able to significantly reduce formal training of agents following the implementation of powerful technology-based solution that redefines how learning and performance support is offered to new and current agents.
Developed and implemented by Johannesburg-based specialist learning consultancy Hi-Performance Learning (HPL), a member of The IQ Business Group, the solution has also reduced the need for specialised agents to tackle complex client queries as less experienced agents can now field these calls.
According to HPL director Ryan Falkenberg, by capturing the knowledge of expert agents in intelligent formats that effectively guide less experienced agents through complex and integrated service, operational and decision-making processes, the call centre is able to recruit agents who specialise in client service rather than medical insurance. Not only do these agents cost less, but they offer the differentiator that the call centre seeks.
"In addition, the solution has significantly reduced risk to the medical insurance company because correct and accurate information is communicated by all agents in a consistent way," he says.
HPL was called in to assist the medical insurance company's call centre to deal with a myriad of complex challenges. Because the 60 agents in the call centre are responsible for servicing clients in nine US states, the number of potential medical queries that any agent can receive is estimated at around 50 000, with each state's laws impacting on how the query needs to be handled.
The pressure on agents is enormous, resulting in high staff turnover. In fact, the complex content and long training times meant that some agents were in training for longer than they were actually working for the company.
In addition, the complexity of the business content (huge volumes of information relating to medical conditions, insurance products, the way medical benefits apply in different States according to legislation, the type of membership, and the various exclusions) meant that agents had to be specialised or recruited with medical knowledge. And the rate of change in products, processes, systems and legislation and policy rules meant that all agents required ongoing refresher training.
"The disparate nature of documentation and information within the business (related information existing in multiple places and at varying level of accuracy) also resulted in agents spending significant time tracking down the right information while the client waited on the line -sometimes up to 45 minutes. The result was low customer satisfaction," Falkenberg says.
"The solution therefore, was to find ways of supporting agents in handling complex client queries without them necessarily needing to know the answer in their heads."
To achieve this, a detailed review of call centre queries was conducted to identify where the greatest solution impact could be achieved. High impact processes (frequently used and/or important), products, system steps, and compliance rules were identified for the first phase, and top performing agents, process experts, product experts, compliance experts, and service experts were invited to co-design an integrated call process that would assist any agent tackle 80% of predicted calls in the most accurate, optimal way possible.
Once a detailed, integrated call process was defined (including scripting guidelines as well as system support), it was then captured into an online performance support tool (PST) using CUDA Coach.
CUDA Coach is a powerful performance support technology that converts complex processes and logic mapping into an 'intelligent' electronic performance support system (EPSS). This EPSS effectively guides the user through any activity-based or decision-making process, linking them to the right content at the right time, and removing the need for organisations to train staff in all the process and content details.
"Effectively, the agents are guided through the call, and given the confidence that they are following the correct service and operational process, and performing the correct system step, while being provided with the correct response based on the client query," Falkenberg explains.
The impact was almost immediate.  In addition to improved customer service and more productive and self-assured agents, retraining to accommodate ongoing product, process, system, legislation and policy changes has been all but eliminated, with the focus shifting to EPSS-logic maintenance rather than version-controlling agent's brains.
"Staff have reported that the EPSS has enhanced their comfort in their query resolution, and enables them to focus more on client service than simply trying to provide the right information. At the same time, team leaders are now more able to focus on value-adding tasks, rather than spending most of their time shadowing agents and answering queries that agents are unable to handle," he adds.
"This effectively enables the call centre to speed up the time to competence of new agents and reduce ongoing performance support, while seeing enhanced performance and reduced risk."