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Personalized Service at UPMC Health Plan

“I spoke to Kierra. She was so nice and this is the best I've ever been treated with a health care company. This is the second time I called and got great service. I am loving this insurance. I've never had a health insurance that will call the hospital and see what is going on with a claim with me on the phone. It's making me feel really good. Thanks Kierra. You did a great job and made me feel wonderful.” -UPMC Health Plan Member

UPMC Health Plan at ICMI Global Contact Center Awards

At UPMC Health Plan, we receive hundreds of comments like this each day.  Our call center team is committed to our mission of Service Excellence and Improving the Health of our Members.  We have deployed this through our unique and well-established Health Care Concierge program, bringing a personalized touch to serving our members.  This program partners the member with a Call Center representative who acts as his or her personal guide through the complex world of health care.  The concierge teams are responsible for creating an experience that drives the feeling that there is someone at UPMC Health Plan who genuinely cares about the member, and their health and well-being.  The Health Care Concierges help the member quickly resolve issues, act as an advocate, and connect the member to programs and resources they may not have known about.

When the member calls, our Genesys phone system recognizes the caller ID, searches our core system for the member who has this phone number and routes the call to the personal concierge.  If the concierge is not available, it will route to another concierge on the team.  

This approach to the member experience is what differentiates us, along with a focus on First Call Resolution and Member Experience.  Our Health Care Concierges have a goal:  the call does not end until the problem does which increases member satisfaction. Our Concierges feel they have made a difference, and future volumes are reduced.  Our Health Care Concierge Program also features High Touch Outreach Campaigns such as welcome calls, pharmacy authorization, birthday calls featuring preventative care needs and many others. Our call center has been so strong that our marketing team is able to use this outstanding experience that we are creating to advertise our business.  

Join Anne at Contact Center Expo & Conference to learn more about the UPMC Health Plan approach to personalized service. 

We are so passionate about ensuring we handle each call in the best way that we offer every member our After Call Survey. In 2015, we created a dedicated Member Satisfaction team that focuses on FCR and service recovery.

On our Genesys After Call Survey, if the member responds “No” to the FCR question, a work item is immediately routed to a Customer Satisfaction Specialist dedicated to FCR Service Recovery.  The interaction is investigated and we call the member back to service recover them.  We measure how quickly we call the member back and how many we have completed, with the goal of reaching back out to the member within two hours.  

The key focus of this program is on root cause and preventing the same issue moving forward.  The opportunities that we find may be coaching, training, improving a process, working with another department to change; with many of the improvements reaching far beyond the contact center.  These are documented and followed up on with a report out to Sr. Leadership every week.  

Through this VOC program, we have established and evolved our FCR achievements over the past year. Our First Call Resolution score measured by our after call survey is 97.2%, up from 95%.  As measured by SQM, we moved from 72% on FCR in 2015 to 78% in 2016, while the average call center is 71%, and average for health care is 70%.  

By living out our mission in the member experiences we are creating, we have created strong loyalty, allowing us to enjoy a strong member retention of 98% (compared to 92% for other healthcare companies).  With the assurance we have established through the call handling and FCR dedication, our Health Care Concierge Program has become esteemed not only at our company, but is the brand that we deliver in the market to sell our business.  Our team members take the highest level of pride through in the feedback they are getting from members they talked to, knowing they are making a difference in people’s lives.

“The concierge on the phone was extremely helpful. That was one of the best calls I've had at an 800 number. He went out of his way to call the pharmacy on my behalf to get through the paperwork for the medication that my son needed. So, top notch. Thank you.” -UPMC Health Plan Member