OptumCare - Customer Service Department of the Year

Company: OptumCare, Phoenix, AZ
Company Description: OptumCare is a hybrid organization offering health and wellness initiatives to members, as well as claims payment, physician networks, customer service, benefit interpretation, and community centers for members. Our company was founded in 2010, and works with patients to improve their interactions with the health care system.
Nomination Category: Customer Service Department Categories
Nomination Sub Category: Customer Service Department of the Year – Healthcare, Pharmaceuticals, and Related Industries

Nomination Title: OptumCare

The driving force behind the success of OptumCare’s Service Center is our Service Model. It serves as a guide and standard, which all of our employees strive to uphold and enhance. Employees are encouraged to go above and beyond in their work, and enthusiastically treat the customer’s problem as if it were a problem of their own with three main focuses in mind: Stakeholder satisfaction, Culture of Compliance and The Power of One Mentality.

We strive to deliver a high degree of satisfaction measured through NPS and other verbatim feedback where we have held a NPS score of 70+ for five years straight, with a corporate goal of 50. We look for opportunities to ensure a culture of compliance through our internal quality scores of 97% for three+ years, as well as 90% in First Call Resolution on a goal of 80% for five+ years. This performance has allowed our team to grow from 20 advocates in 2012 to upwards of 200 in 2020, supporting 7 markets and branching out in four national Hubs and incorporating international

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

97% internal Quality scores

NPS score of 70+

27 second Average Speed to Answer

Sent over 2500+ hand written notes to members thanking them

Enhanced focus of our new hire program- DA program implementation and a New Hire ambassador program as well as new hire curriculum

Implementation of a CPT code tool and Claim Denial Code tool

Partnered with the Voice Analytics team to deliver insights into processes, provide recommendations for improvements to increase NPS, lower AHT, and automate

Decreased Average Handle time by 500+ seconds.

Implemented a tiered approach in which a team of tenured advocates have both customer service training and claims processing training, where they process claims on the spot, cross training of advocates who can support both Prior Auth and customer service inquiries, a Direct Member Reimbursement specialist, as well as an Subject Matter Expert helpdesk who assists with both internal and external escalations.

Strong focus on our response to Covid-19 and its impact to customers and employees

Implementation of leadership blogs, monthly surveys, quarterly town halls and virtual huddles to maximize leader communication

Hosting and implementation of NPS workshops and NPS champion program

Implementation of enhanced leadership training

Completed a 90 day culture challenge to better ‘permit what we promote’

Implemented a Bright Ideas Program for innovation

Participated in an Enlighten Pilot Program where we interpret every interaction and transform behaviors into data that drives better performance

Implementation of Production tool TNOC Omega

Implementation of IVR self service for claims and Benefits/Eligibility

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 department's past performance (up to 250 words):

Our commitment to quality customer care, adherence to our Service Model, implementation of innovative and efficient concepts, and unrivaled proficiency serve as indisputable evidence that OptumCare’s Service Center is at the forefront of the customer service industry.

Throughout 2020, we focused on driving efficiency, removing barriers, and enhancing the customer experience for our current clientele, but also found innovative ways, like the creation of our COVID-19 Telehealth Team, to stay connected to and focus on the ever-evolving needs of customers and employees in the onset of the pandemic.

We are continually focused on building and enhancing our relationships and are looking for ways to maximize leader communication with our employees and address potential barriers personally and professionally for maximum work/home life balance and to drive performance. We prioritize the development of our team members, to not only maximize performance within their current role, but to promote internal movement/promotions and retain staff. We have extremely high expectations for all levels of staff to ensure we are efficient and drive scalability, all while never sacrificing the quality of the member and provider experience. We have been able to prove to our existing clientele that not only can we can meet and exceed expectations year after year, but that we are scalable, can adapt quickly to change, and consistently push ourselves to the next level. This can be seen in our efforts in implementations, automating processes, having customer/employee feedback drive our action planning, and focus on efficiency to enhance the experience overall.