Customer Service Solution Answers The Blues' Call
Insurance Networking News, May 2004
Time is a critical element of virtually every business process, but it is particularly crucial for customer service. When Providence-based Blue Cross and Blue Shield of Rhode Island (BCBSRI) decided to improve its call center operations, it established several goals, one of which was to reduce the average handling time per call by 20%.
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"We certainly had an opportunity with every call and every inquiry to have a good experience for our customers," says Stephanie Ledoux, assistant vice president, customer and provider service.
She notes the average handling time was about 10 minutes for each of the 4,000 calls per day the insurer received. About three-fourths of the calls came from customers; the rest were initiated by health care providers. The insurer wanted to shave about two minutes from the average handling time.
BCBSRI executives also wanted the new call center system to be easy to learn so the company could reduce the training time for new hires from 10 weeks to eight.
A third objective was to create a robust reporting system that would enable the insurer to analyze the types of calls it was receiving and identify ways to improve its business processes. "We were looking for something that would provide us with real-time trend analysis," Ledoux explains.
The call center makeover was just one part of a larger corporate re-engineering effort. "Our organization decided about two years ago that we were going to look at how we serviced our external customers," Ledoux says. "We know that our interactions with our customers have a major impact on their perceptions of Blue Cross and Blue Shield as a company."
Getting started
The first step occurred in July 2002 when BCBSRI called in Watch Hill Partners, a Providence, R.I.-based consulting firm, to conduct a gap analysis on the existing call center. That analysis identified areas where the insurer could improve.
For example, the existing system made it difficult for call-center representatives to find needed information. "Customer service reps were navigating multiple screens just to answer one question," Ledoux says. "It was an antiquated way of handling a customer inquiry."
The gap analysis report served as the basis for the business case presented to senior management explaining why a new application was necessary.
Once the decision to go forward was made, Ledoux put together an internal team comprising representatives from other departments, including sales and marketing, claims processing, IT and membership.
This team worked with Watch Hill Partners to establish a set of criteria for the new call-center system and to conduct the search for a vendor. After an initial review of 23 vendors, eight firms were asked to submit proposals.
"Based on our business requirements and what we wanted to do, we were able to eliminate some of the vendors that weren't able to meet them," Ledoux explains.
BCBSRI decided in December 2002 to go with the PegaHEALTH Member Services Application from Pegasystems Inc., a Cambridge, Mass.-based provider of rules-based business process management software.
Called BlueLYNCS (Leading Your Next Customer to Satisfaction) by BCBSRI, the application includes 41 health care workflows and screen pops, and is integrated with the insurer's legacy systems with full update functionality. The application also automates common functions-such as resolving claim inquiries and ordering ID cards and enrollment forms-across all contact channels.
A couple factors gave Pegasystems the edge, according to Ledoux. "They had a good in-depth knowledge of the health care industry," she says. In fact, Pegasystems applications are installed in about 20% of the plans in the Blue Cross/Blue Shield nationwide network.
In addition, many of the desired workflow functions were already built in to Pegasystems' software. "We weren't going to have to spend a lot of time re-inventing the wheel," Ledoux says.
Ambitious schedule
Work on implementing the new application began in March 2003. Watch Hill Partners helped manage the project and keep it on its rather ambitious schedule. "Our goal was to have the application ready for deployment by the end of September," Ledoux says.
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