Elevating the operations of Puerto Rico’s largest private healthcare plan through streamlined processes
Overwhelming Demand: As Puerto Rico’s premier private healthcare plan serving 700,000 members, the Client was strained by demand that surpassed their staff and facility capabilities.
Supplier Issues: Numerous bureaucratic hurdles with their domestic supplier impeded quick access to vital compliance reports and support.
Operational Hiccups: High operational costs coupled with inadequate customer service and unsatisfactory KPI metrics became major bottlenecks that they sought to overcome.
Swift Recruitment: Despite tight time constraints, we recruited and trained a team of 50 dedicated agents.
Process Overhaul: Streamlined operational processes were implemented, doing away with unnecessary bureaucracy.
Compliance Assurance: The team ensured timely and accurate compliance reporting, consistently meeting the set Service Level Agreements (SLAs).
Enrollment Management: Support was optimized to efficiently navigate the challenging open enrollment period.
Proactive Campaigns: The agents ensured CMS compliance and spearheaded call campaigns reaching thousands during the crucial enrollment period.
Operational Flexibility: Operations were strategically scaled to address regular call volumes as well as peak times during enrollment spikes.
RESULTS & CLIENT BENEFITS
High Volume Management: Effectively catered to a monthly call volume of 65,000 calls and handled surges of up to 200K calls during the open enrollment period.
KPI Achievement: The team consistently hit the targeted KPI benchmarks.
Enhanced Reporting: Efficient compliance reporting mechanisms were implemented.
Boosted Satisfaction: A significant uptick in customer satisfaction rates was experienced.
Adaptive Capacity: The operational capacity was scaled effectively and efficiently in response to fluctuating demands.