High quality health plan customer service is critical for payers who want to create meaningful, positive beneficiary interactions.
Customer service plays several important roles for health plans. In addition to the stand-alone goal of leaving members with a satisfactory experience, the quality of customer relations is included in NCQA’s HEDIS measures, one of the most common scoring frameworks for health plans.
The top performing health plans are graded, in part, based on how beneficiaries view their experiences with customer service representatives and interactions with overall health plan services.
Even the top rated plans garnered some negative reviews from members around sharing benefits information, reviewing member claims, and issuing healthcare appointments in a timely manner, indicating an opportunity for all health plan providers to improve their service-oriented mindsets.