Contact Center Outsourcing for Healthcare Plans

The CMI Group is the premier provider of contact center outsourcing for healthcare plans. We help you to surpass quality performance standards and grow your membership base. Our contact centers support all lines of commercial healthcare plan coverage including: Commercial, Medicaid, Medicare Advantage, Medicare Part D, PBM Help Desk, POS Discount Plans, and Wellness.

Our healthcare plan support services include:

• Open enrollment support
• Benefit and eligibility inquiries
• Customer service
• Claims status and adjudication
• Coordination of benefits
• Member retention and outreach
• Healthcare exchange navigation

CMI’s contact centers not only help healthcare plans to improve member experiences, member acquisition, quality, and retention, but they also help the healthcare plan streamline its operations. CMI has everything perfectly aligned to the goal of supporting and growing your health plan’s membership base including:

1. HIPAA-Trained Agents

To ensure your continued compliance, our service representatives receive thorough HIPAA training ensuring they follow security protocols when interacting with your members. We work closely with you following all regulatory guidelines regarding data ensuring it is protected when utilized.

2. Compassionate Communication

When members contact healthcare plans seeking guidance and reassurance, some of them are in a distressed emotional state. CMI service representatives treat the members with compassion. Empathy often plays a significant role in creating an excellent member experience, especially when the member is in an emotional state. CMI utilizes a speech analytics tool to interpret agent tonality and word choice. We use the speech data to coach for compassionate communication resulting in the best possible experience. We also monitor metrics such as first contact resolution, abandonment rates, and degree of engagement.

3. Flexible Staffing Options

CMI has physical contact center facilities as well as a work-from-home solution. Additionally, CMI offers accent neutral near-shore and off-shore resources as a cost savings option.

4. Bilingual Support

As the healthcare industry serves a diverse demographic, CMI provides service representatives that are English fluent or Spanish bilingual.

5. Training

Our service representatives undergo a comprehensive training curriculum during onboarding. In training our service representatives learn about your health plan’s mission and culture as well as:

• Customer service skills
• System(s) and usage
• Calling guide materials including FAQs, website links, and call scripts
• Compliance requirements HIPAA
• Quality expectations

After service representatives have finished a training section our trainers leverage our learning management platform’s knowledge retention features to reinforce key learning points. Our agents are required to successfully pass all quizzes, exams, and demonstrate proficiency on the phone before graduating the program ensuring your agents are well prepared before taking member calls.

6. Quality

According to a Guidehouse study, improving from a 3 star to 4 star rating could increase revenue between 13.4 percent and 17.6 percent through increased enrollment and additional bonus payments. CMI has a comprehensive approach to improving the consumer experience and your Star Rating. Our goal is to provide a seamless communication to your members as an extension of your customer service team.

Our Quality Assurance team continuously evaluates agent performance and knowledge during their calls. The performance of the agents is evaluated to the same high-level standards that you hold for your in-house team. CMI ensures top quality by:

• Conducting regular calibration calls with your team
• Following closely all policies and procedures
• Meeting and surpassing service performance expectations

7. Omnichannel Support

Members today want to get the assistance they need via their preferred channels of communication like – phone, email, chat, text, etc. We offer an omnichannel solution with standalone deployment or through integration with your existing infrastructure. CMI’s agents can rapidly and effectively provide service at every touchpoint throughout the member journey, allowing members to switch channels seamlessly at any point of time.

8. Following Data Security Protocols – HIPAA and PCI-DSS

Electronic Health Record (EHR) and Individual Health Records (IHR) are stored and transmitted in compliance with HIPAA regulations to prevent security breaches and protect Personal Health Information (PHI). Providing critical assurances, CMI’s external audits verify our compliance with all required data security laws, regulations, and standards including:

• HIPAA
• PCI-DSS
• SSAE18 SOC 1 and SOC 2 Type II

Take Action

If you need a hand answering calls or meeting service level objectives, then outsourcing your health plan’s contact center to CMI can bring an unrivaled customer service and significant expense reduction. Click below to connect with us: