CASE STUDIES

Inbound Customer Service for the Pennsylvania Department of Public Welfare in support of the Affordable Care Act

Project at a Glance:

• Variable Staffing
• Spanish language CSRs
• Healthcare insurance support
• HIPAA

THE NEED

When the Affordable Care Act (ACA) was signed into law in 2010, it set into motion significant changes to the entire healthcare industry. A key provision of the bill was an individual mandate requiring all individuals to acquire health insurance. All citizens needed to know about the changes and have a vehicle through which they could apply for health insurance. In August 2013, the Pennsylvania Department of Public Welfare contracted with InspiriTec to establish the Affordable Care Act (ACA) Consumer Services Center that would:

• Handle a high-volume of calls
• Handle a wide range of consumer inquiries
• Service a diverse population
• Help individuals apply for health insurance over the phone
• Verify the insurance application process through an audio signature

THE SOLUTION

InspiriTec worked with the DPW to create a flexible solution that resulted in the ACA Consumer Services Center. Customer service representatives were trained to answer a variety of questions about the ACA without the use of scripts and to help individuals remotely fill out an application for insurance through the state’s COMPASS online benefits application program.  Once calls are completed, InspiriTec employees provide callers with “next steps” procedures. Throughout its engagement, InspiriTec has maintained a 97.7% or better customer satisfaction rating.

In order to accommodate the high volume calling that takes place during open-enrollment periods, InspiriTec established a variable staffing model that could scale up or down depending on monthly needs.  Given the need to secure confirmation from callers before submitting an application through COMPASS, InspiriTec also worked to develop a unique call tracker system that records an applicant’s verbal confirmation that he/she is submitting the health care application and the Department is authorized to proceed with application processing.

Other key features of the center include:

• Spanish language service representatives
• Establishment of a set of clear customer service guidelines
• Automated Call Distribution (ACD) system and Interactive Voice Response (IVR) functionality that provides content specific messages in English and Spanish to consumers on a 24/7/365 basis

Beginning on August of 2016, InspiriTec began answering and processing over 1,000 CHIP COMPASS application requests monthly. As of January 2016 InspiriTec began processing 1095b calls with questions and reprint request during the January to mid-April tax season.