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: DRIVING SUCCESS ACROSS THE HEALTH PLAN: INFLUENCING CHANGE THROUGH THE EMPLOYEE AND MEMBER EXPERIENCE

UPMC’s vision is to lead the transformation of health care by putting our patients, health plan members, employees, and community at the center of everything we do and creating a model that ensures every patient gets the right care, in the right way, at the right time, every time. World Class Service is our overarching value at UPMC, and we believe this starts with us:UPMC Health Plan’s Enrollment & Coordination of Benefits (COB) teams.

Our teams care to ensure members are enrolled timely, in the right plan with the right coverage coordination, enabling members get the critical access to care they need, when they need it. Whether filling a sick child’s prescription or obtaining a potentially lifesaving mammogram, our teams get it right. To us, our work is not just back-office; it’s someone’s life, and how we care for it can make a difference in someone’s experience, care, and overall health.

Focusing on excellence and caring has produced outstanding business performance:

Consistent YOY growth, while maintaining KPIs, achieving performance guarantees, and adhering to state/federal regulations

-$982M+ in Medical/Pharmacy COB Savings (2021)
-Strong Employee Engagement Scores
-Outstanding Audit Performances & Operational Training/Quality Programs
-Award Winning Customer Service across the organization

Coupling excellence and a drive for innovation, we continue to achieve amazing results impacting our members, our employees, and our partners across the organization:

-In response to COVID-19, we executed a full transition to remote work in March 2020 (over 260+ team members!) This sudden change challenged our culture, employee engagement models, and presented new challenges for our teams. UPMC leaders and team members responded extraordinarily! Productivity increased 19.5% since transitioning to WFH!

-Between February and April 2021, 35% of our “back-office” team members volunteered to trade their normal day-to-day work to support COVID-19 Vaccination efforts: a total of 22,251 inbound calls relating to COVID-19 were serviced by them!

-Our community support went beyond inbound calls: A total of 1,543 hours of in-person support was provided at our community vaccine events!

Connecting our Members with the Expert, our Enrollment & COB teams made 56,929member outreaches to educate members on Enrollment or COB processes directly impacting them.

Focused efforts to reduce claims adjustments led to business process improvements across Finance, Claims Operations, Benefit Configuration, and other operational teams: Reducing adjustment requests by 82% (2020/2021 Q4 comparison)!

-New enrollment advancements made across all teams supported business and sales strategy development, leaders to have meaningful conversations about performance, and giving team members autonomy and empowerment within their roles.

-Our continued commitment to Diversity & Inclusion delivered new ways to engaged team members through new communication methods, and we graduated 7 team members from our 2021 Diversity Mentoring Program!

Our Enrollment & COB teams embrace the responsibility of caring for all the tiny, invisible details that ultimately support a successful, enjoyable member experience. This is why our Enrollment & COB Mission Statement is “A World Class Team Delivering World Class Service”, and our Vision Statement expands upon this:

Ensure effective & efficient member onboarding and maintenance for all members through
-Teams of skilled & caring individuals who consistently strive for excellence
-Fostering a culture of commitment & accountability, while maintaining the highest level of quality & compliance
-Identifying & driving ongoing process improvement culture

We know our success is a direct result of our team members’ care, compassion, and overall engagement. When we take care of our team members first, they take care of our members! Through this thought leadership, we recruit, train, and retain team members who truly care about the work they do and the people they serve. We care for our team members throughout their journey with us by providing a robust onboarding program and career path.

Connecting with team members in a new virtual world has presented a challenge, but not one that we haven’t been able to overcome with intentional leadership. We create formal and informal connection opportunities to provide and collect meaningful feedback, connect personally, and establish team camaraderie and connect: Coffee & Connect Socials, Operation Connection, Bridges Sessions, and more, are scheduled regularly on our teams.

What makes UPMC Enrollment & COB Teams unique? Our People.

Our success is rooted in the following key categories:

Influencing Change Across the Health Plan: How the work we do in the back-office has driven process improvements interdepartmentally, how our data and analytics have supported business and sales strategies, and how we care about our patients, members, communities, and each other – even if it “Isn’t in our job description”. A special highlight to look for here is our COVID-19 response!

Driving Success with Employee Engagement: In a new virtual world, we have had to establish new ways of formally and informally connecting. Focusing on employee engagement has led to significant gains in efficiency while maintaining a strong employee engagement. Creating space and dedicated time to connect and listen to feedback, from all levels, and then taking the time to act on it, has been crucial to our ongoing growth and strong performance.

Driving Success with Member Experience: We work relentlessly to ensure all the work we do in the back-office is completely seamless to the member. When they arrive for the critical care they need, their coverage works because we care for those details, including upstream and downstream details. If the work we do does have a direct member impact, we pick up the phone and call them to let them know proactively.

We hope you will enjoy learning about the incredible work our teams do each and every day. To say we are proud of them is an understatement; they are truly Quiet Heroes!