UPMC Health Plan - Back-Office Customer Service Team of the Year

Company: UPMC Health Plan, Pittsburgh, PA
Company Description: UPMC Health Plan is among the nation's fastest-growing health plans. It is owned by UPMC, a world-renowned health care provider. The UPMC Insurance Services Division offers a full range of group health insurance, Medicare, Special Needs, CHIP, Medical Assistance, behavioral health, employee assistance, and workers' compensation products and services to over 3.6 million members.
Nomination Category: Customer Service & Call Center Awards Team Categories
Nomination Sub Category: Back-Office Customer Service Team of the Year - Other Service Industries

Nomination Title: Innovation in the back office: Improving Quality, Accuracy, and Member Experience

Our award-winning Health Care Concierge program differentiates our business in a competitive market by delivering on world class service and member experience. Delivering on this promise starts in the back office with our Enrollment & Enrollment & Coordination of Benefits (COB) teams, who play a critical role in ensuring a positive member experience, both upon initial enrollment and throughout their membership journey. To ensure our customer service strategies are deployed consistently, we have uniquely structured our organization to have Member, Retail, and Enrollment Services all reporting to the same Vice President. This structure creates a partnership enabling team members in the back office to feel just as connected to the member experience as their partners in Member & Retail Services. This structure and focus have been quite successful for UPMC:

-Membership growth of 13% (average) since 2010, while maintaining KPI performance, achieving performance guarantees, and adhering to state and federal compliance regulations
-Real time back office support through live chat/voice help desks innovative “Instacut” process
-Dedicated team members (23 total) who flex their time between Enrollment/COB and Member Services
-Back office team members talk directly to member in matters of specific Enrollment/COB situations, ensuring Expert care and communications

Outline the team's achievements since July 1 2019 that you wish to bring to the judges' attention (up to 250 words):

Back-office innovation in Enrollment/COB this past year truly demonstrate our commitment to ongoing process improvement and organizational success:

-Launch of New Enrollment Systems (slides 19-22)
-Pennie: State Based Marketplace Exchange system
-EmployerPlace: An automated Commercial Enrollment Renewal platform
-EMMA: Medicare Enrollment Processing system, co-developed through a joint partnership
-Expanded InstaCut processing, ensuring member requests are processed in near real time; 103,635 requests processed in 2020 (215% increase from 2019) (slides 30-31)
-Developed self service options for Members for 1095Bs and Plan Change requests via our Member Portals (slides 24-25)
-New Member Touchpoints, ensuring the Back-Office team members have direct communication with our members – 37,660 outreaches conducted (slides 40-44)
-New COB proactive approaches to maintaining accurate COB data leading to a 49% increase in COB Savings from 2019 to 2020 ($1.2B saved in 2020) and a reduction of 93.4% of claims adjustments for our Medicaid product (slides 37-38)
-A total of 160 hours of Enrollment/COB specific training was provided to Member Services (slide 32)
-Automated chat routing improved turnaround time by 2.5 days (slide 33)
-Implemented Voice of the Customer Surveys for Outbound calls; 573 respondents reported a 4.9/5 Overall Satisfaction (slides 45)

Explain why the achievements you have highlighted are unique or significant. If possible compare the achievements to the performance of other players in your industry and/or to the team's past performance (up to 250 words):

Regardless of role or department, UPMC creates a culture focused on care, compassion, dignity, and respect. Focusing on people first enabled us to keep team members engaged and committed during a year of continual change:

-We launched a new Enrollment/COB specific Mission & Values statement to help team members connect to our purpose and find meaning in their roles (slide 5)
-In response to the COVID-19 pandemic, we executed an immediate transition to a full Work at Home Model, moving 260+ team members overnight. This sudden change challenged our culture, employee engagement models, and presented new challenges for our teams. UPMC leaders and team members responded extraordinarily! Our transition to full time WFH led to a 27.7% increase in overall productivity in 2020. (slides 12)
-During the COVID shutdown, 18 Retail team members were crossed trained in Enrollment/COB and completed 11,701 items during this time. (slides 11)
-Racial and social injustices in our communities deeply impacted our team members. UPMC responded quickly to these social calls for action, both at Executive and Team levels. (slides 15-18)
-New engagement models and recognition models were deployed to better fit a fully remote model (slides 13-14)

Reference any attachments of supporting materials throughout this nomination and how they provide evidence of the claims you have made in this nomination (up to 250 words):

Beyond items already cited, we are excited to share with you evidence of our commitment to our ongoing process improvement and success this past year:

-UPMC COVID Response Feedback from Leaders & Team Members (slides 8-9)
-New Onboarding Process to support a new full WFH Model (slide 10)
-Creating opportunities for important dialogue about social injustice, diversity, and inclusion (slides 15-18)
-Special Highlight: “Through Their Eyes” Series, featuring Employee Experiences
-New Enrollment Reporting Innovations to support Business Operations internally and across the organization (slide 26)
-Streamlining the Commercial Enrollment Application process (slide 27)
-Centralizing all Member initiated Claims Adjustment Requests with COB has resulted in improved reporting, driving Health Plan wide process improvement initiatives (slide 28)
-Special Highlight: Hear how this has impacted Member Services! (slide 29)
-Automating member maintenance for impactful eligibility components, saving ~$260k annually (slides 34-35)
-New Instant Eligibility Query tool for our COB teams improves employee experience and data accuracy, while saving ~158k annually (slide 36)
-Expanded Back-Office Outreach efforts to care for premium changes, transition of care for new members, and more (slides 40-44)