In remote offices across the country, we host a large group of service agents that help everyday people navigate the ins and outs of their health care plans. Call them care Sherpas, call them masters of the coverage gauntlet – whichever metaphor you choose, they all mean one thing: health insurance professionals. One of their best, Helpdesk Customer Service Representative Marjorie Grill, shares what her routine as one of these agents is like for our latest Day in the Life story.
“These alerts are typically call drivers, and a quick overview in the morning can allow you to have the answer ready if a member calls about it.”
And call they will – no two queries are alike, and our healthcare agents will always field numerous questions throughout the day.
“Most of my day is spent taking calls from members and providers, assisting with a variety of tasks,” Marjorie adds. “Some calls will be a member having surgery and wanting to know what their cost share will be for that service, or a provider calling to see why a claim denied and how they can appeal the denial. Sometimes it’s as simple as taking a monthly premium over the phone.”
But what about times in between calls?
“In between calls I work on what we call briefcases. These are essentially messages we send straight to our client and their responses. An example of a briefcase would be sending a claim back for review and clarification as to why it denied, and a client claims processing agent will send a response back with more details. This response is then relayed to the provider or member to allow the appropriate next steps to be taken.”
If you remember our Day in the Life TAC feature, David Lehman shared how a TAC associate is constantly improving as new safety features, engineering notes and other information comes to light in real time. If the human body is a complex machine, and the laws of health care are as labyrinthine as a car, it’s important that agents like Marjorie stay on top of the latest tips in careful call handling and plan updates.
And she’s present for all of these updates: “We have meetings on a weekly basis to go over any changes or call drivers that will assist us during our calls. We also have one-on-one meetings with our Team Leads and Quality Assessors; every month, agents have 10 random calls reviewed and scored, so meeting about these scores is imperative to keep improving and servicing our members in the best way possible.”
The whole team goes through this process of continual refinement and improvement so our clients are represented well – and their customers know they’re getting the best service possible at a time when they may be confused or stressed.
And even though she works from home, Marjorie hasn’t let that fact keep her separated from the rest of her team when it comes to asking questions or double-checking cases.
“This is very much a team effort! Working from home can make you feel like you are on your own, but there are so many people ready to help; there is a lot to remember within this job. It’s almost impossible for one person to remember, or experience, all of it, and no matter how long you have been here, you will still need to reach out and ask for help. I might not have experience with filing appeals, but perhaps someone in my team chat has come across this situation before or vice versa; we all have different strengths. It’s important to realize that and humble yourself, knowing that the correct answer is more important than wanting to do this on your own.”
Did you know that, due to HIPAA law and other confidentiality agreements, our healthcare associates have to make sure there’s no way outside eyes and ears can see or listen in on client information? While Morley operates on high levels of client privacy, this is especially true for the health care space.
But this level of privacy isn’t just for customer protection, either – it creates a space of one-on-one interaction that can create some awe-inspiring moments for our customers every day. Marjorie recalls one such instance when, “…an agent called in stating the member had a bill for $683.98 but could not locate that amount anywhere to verify if the member truly did owe it. After searching unsuccessfully for a few minutes, I finally asked the agent if there was an address to send the money to on the bill the member was holding, thinking if we could figure out where the money needed to be sent, we might have a better idea of where the bill came from. The agent came back on the line – upon researching the return address, the bill the member had was for his AT&T phone bill, not his health insurance, so she politely informed him that he will have to call the phone number on the bill for any further questions.”
“It’s a great example of why probing questions (who, what, where, when and why) are so important!”
While it’s great to share it’s a bill from somewhere else, not every call has an easy resolution, and a prospective health care agent will have to be emotionally ready for some trying times on the customer’s end. “I had a call from a client who was staying in a mental health facility concerned about the care he was receiving while there. He was clearly scared, and with his one allowed phone call, reached out to us, as his insurance company, for help.”
“I was able to keep him on the line and connect him with a team who is dedicated to situations such as his. While this was a tough call to take, having the resources available to assist him and improve his situation makes all the difference.”
In a time when many believe the art of extraordinary client care is dead, agents like Marjorie take calls and represent our clients with the best possible customer service. “I hope that I make them feel valued and heard in addition to solving whatever has caused them to call us,” she explains as a driving factor for how she makes a difference every day. “My grandfather and I have been involuntarily separated for the past 10 years, and I try my best to treat every member as I hope someone else treats him if he ever needed this assistance.”
“No matter how busy we get, I never think of this as just the next call; there is someone else’s grandparent, parent or spouse on the other end of my phone that deserves my individuality and respect.”
With agents like Marjorie on the case, it’s no wonder our client looks to Morley for its health care service needs – and why they continually award our team on a near-annual basis for their high-quality customer care.
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