How the evolved administrative requirements have impacted the level of customer service an insurer must provide
What has changed with customer service? In my last post, I mentioned the old days – way back in 2010, when it was Self Admin or Full Admin. Ah yes, those days of crystal clear expectations, where you knew what your role was and what you did or did not do. Back then you could simply underwrite the case, manage the risk, and pay claims. Throw in a little online Medical Underwriting or tablet based enrollment and presto, you were exceeding expectations! But, did you know who you were insuring? Like, really know who you were insuring, so if they called you, you could very easily inform them of what type of accident insurance they had in force and provide them with exactly how much they would be reimbursed if they lost a limb? Probably not. But that’s OK – you weren’t alone.
What about eligibility? Could you provide the spouse of the employee a quality review of their enrollment options based upon what the EE was approved for and what time of year it was, given their eligibility class across all products? No.
Billing – could you bill accurately and properly for a Group Voluntary case? Did you think Voluntary was a corporate service project? We’ll cover that one a bit later in the series…
Back to service. This isn’t “forget-insurance” anymore. The customer service needs are comprehensive and require accurate and up to date data.
At a high level, there are now four areas most insurers need to support in order to provide adequate, and potentially leading, customer service, whether you are Self Admin, Full, or somewhere in between:
- Customer support (both call center and digital): What do I have and what does it cover? As mentioned earlier, consumers need to know this. As the burden of insurance has continued to shift from the employer to the consumer, they really need to understand it too. Considering the continued proliferation of high deductible plans and tiered products, there are more gaps in coverage than ever before. Throw in the new products now offered at the worksite or through the employer, and things are complicated! You don’t know what you don’t know. Obvious? Yes. Easy to fix? Not so much.
- Eligibility automation: If you are the insurer, shouldn’t you know who you have insured? This is the holy grail of Group insurance historically. We spend all this time underwriting, actuarially studying terabytes of data,only to sell a case and let the employer administer the business, managing eligibility, enrollment rules, etc. – crazy! Luckily this has evolved as the needs and products have pushed for more straight through processing. Data exchanges have gone from a dream to a reality, kind of like ordering your favorite latte from your phone and grabbing it quickly instead of getting the three kids out of the car and waiting -genius. The data exchange provides the insurer current eligibility information and reduces the need to verify with the employer at claim time. It also helps prevent ineligible elections, (allowing someone to be approved for insurance they are not eligible to elect). This creates a better experience for the claimant when they call in, and it brings efficiency to a comprehensive process. The problem is that it’s not easy to setup and maintain. Additionally, when a claim is submitted, you’ll need to know all of the lines of coverage the claimant has in force in order to service him/her adequately and within compliance limits.
- Needs-based solutions: This isn’t Medical or Dental insurance. This is Life and Disability insurance. In most cases, when a claim is submitted, the person calling either lost a loved one, or is going through an incredibly stressful and complicated part of their life. There is more the insurer can do to help the customer during this time, aside from speedy adjudication and payment – which doesn’t hurt. Some of the leading insurers out there have set up an online portal to support the claimant with helpful tools, status updates, and tailored content to provide additional support. Watch this one – this will become the norm.
- Upsell opportunities: Let’s talk opportunity for a moment. What if you knew you had a population that, due to their HDHP plan choices and socio-economic state, were a good fit for new product offerings like Accident, Cancer, and Critical Illness. You could simply offer them those products and they would purchase the needed coverage. After all, this is important protection for them and their families. They receive solid, needed coverage and we bring more entrants onto the plan. Everyone wins! Sounds simple, right? That’s fishing with a worm and probably not the freshest of worms. What if you knew what each individual was enrolled in? Whether they were under-insured? The buying propensity for each individual? The style and channel to reach them? That’s fishing with a net or better yet a grenade. That’s how to sell in the new economy. Consumers don’t want to be under-insured. It’s on the insurer to find the right way to reach them.
In our next post, I’ll cover the Enrollment and Benefits Administration world. The focus will be on the differences between Enrollment and Benefits Administration and how the insurer fits in.