Improve Health Insurance Call Center Scripts by Listening at Scale

Navigating the bureaucracy of health insurance is known to be inconsistent, confusing, and frustrating (even with well-documented health insurance call center scripts). Unfortunately, these frustrating interactions are a common occurrence that many consumers experience while swirling between medical providers, insurance payers, and pharmacies.  

For many healthcare organizations, contact centers are on the front line of these disruptions. They handle large volumes of calls from patients and caregivers on how to manage their health care. In turn, this places enormous pressure on contact center employees to speak professionally and accurately about a highly complex and varied system.  

Customer-centric approaches help reevaluate strategic initiatives, such as refining call center scripts, enhancing agent training, and investing in new technologies to support contact centers (such as self-service, website updates, and expanding into new channels). By addressing the whole person, the healthcare industry is recognizing additional influences on customer behavior and decision-making (outside of transactional reasons)

A study from California Review Management, identified that “a human-centered approach to customer service allows and encourages agents to engage with the whole caller by addressing both their substantive and emotional needs.” This leads to heightened problem-solving, empathy, and more authentic human-to-human connections.  

How are Call Scripts for Healthcare Utilized in a Contact Center?

To enable and support employees, many companies leverage health insurance call center scripts as a road map to address frequently asked questions, follow regulatory guidelines, and align on company objectives. 

Despite communication channel diversification and innovation, phone calls continue to be the most common method of communication, particularly across healthcare– this is why call center script dialogue is a critical component of customer experience (CX). 

“Leverage health insurance call center scripts as a road map to address frequently asked questions, follow regulatory guidelines, and align on company objectives.”

The healthcare system is confusing for customers. That confusion is captured across call centers with examples like this:  

“Do I to get another voucher for this? Because I went through this before, and it was total chaos. I’m baffled.” 

“The reason this mistake occurred is the doctor’s office used the wrong code.” 

“HMO plans you have to stick to one doctor. With PPO plans you can go anywhere you like. You have in-network and out-of-network benefits.” 

Often, this confusion comes from misinformation, conflicting information, and/or getting lost in healthcare jargon, such as: 

  • Specialty pharmacy  
  • Coordination of benefits 
  • Explanation of benefits 
  • Medicare 
  • Medicare Advantage 
  • Medicaid 
  • PPO 
  • HMO 
  • Prior authorization 
  • Affordable Care Act 
  • Bill coding  
  • …and so much more 

These phrases become part of the chaos that leads to confusion and frustration for consumers, caregivers, and patients.  

Navigating these difficult conversations signifies the importance of a human-centered approach across healthcare. By aggregating and understanding current conversations and surfacing trends and topics, organizations can educate employees, refine business objectives, and focus on solutions.  

Transforming the healthcare system starts by understanding that humans are trying to understand humans. This empathetic approach impacts the organization wholly – from health insurance call scripts to customer care to process improvements and employee training opportunities.  

The Critical Importance of Contact Center Agents and Front-line Staff

Front-line staff in contact centers field calls that can be confusing, emotional, and frustrating. Giving reliable and relevant information as a navigating guide is enormously challenging. 

Health insurance scripts are meant to help ensure crucial points aren’t missed, common questions are supported, and potential ways to navigate objections help empower agents to find a resolution.  

Example: Mock Call Script for Health Insurance

A frequently asked question on insurance coverage clarification.  

Agent: It doesn’t change. It’s a PPO plan and an HMO plan. Your copayments are not going to be lowered. 
Patient: What’s the point of having all those different plans? 
Agent: HMO plans you have to stick to one doctor. With PPO plans you can go anywhere you like. You have in-network and out-of-network benefits. 
Patient: Wow, you’ve explained that better than anyone has explained that to me before. 

These healthcare employees are a critical component of the healthcare system and instrumental in promoting a customer-centric approach. However, the contact center can be overlooked as simply a transactional service center rather than a central source of insights and a driver of a customer-centric mindset.  

Leaders need insights on customer needs. Currently there’s a missed opportunity in utilizing a rich source of data that already exists: front-line agents. These recorded conversations provide a neutral, unbiased place for feedback.  

Frequently Asked Questions | Contact Center Best Practices in Healthcare

Scale the Benefits of Healthcare Insurance Call Center Scripts

Healthcare call center scripts are tremendously helpful for alignment on training, but it’s hard to assess actionable feedback on performance without the ability to listen at scale. Feedback may be more anecdotal or based on perception due to resource constraints in manually listening.  

However, there are even more benefits in refining and focusing on what information contact center agents are sharing.  

5 Ways Call Center Scripts are Important for Healthcare Conversations

1. Establish Consistency: Healthcare conversations can cover a variety of topics that require a high level of accuracy and redundancy in order for patients or their caregivers to take the next step appropriately. Call center scripts ensure that all agents are providing the same information and following the same procedures, which reduces the risk of errors or confusion. This helps build agent knowledge and customer trust as knowledge sharing aligns across communication channels for the brand. 

2. Monitor Compliance: In healthcare, there are stricter regulations and guidelines that are in place to help protect consumers (for example, HIPAA is in place to protect sensitive and private healthy information). Call center scripts ensure that agents are providing accurate information in a way that’s consistent and compliant. This helps protect the business and the consumer.

3. Accelerate Efficiency: Call center scripts help agents quickly respond to caller inquiries or concerns. Scripts provide a clear framework for agents to follow, which saves time and improves the overall call center workflow. This can be monitored by assessing metrics like first call resolution rate and average handle time. Unstructured data analysis can help enhance efficiency trends and insights. 

4. Impact Training: Call center scripts are an essential tool for training new agents. Scripts provide a clear outline of what needs to be said during a call and how to maneuver various situations that may arise. This builds employee confidence so they can feel empowered to problem solve and be empathetic to a complicated process. This helps decrease feelings of frustration and defensiveness, as well as process delays. 

5. Assess Quality Control: Call center scripts provide a way to measure the quality of calls and ensure that agents are meeting the organization’s standards for customer service and patient care. Focusing on resolution (over call length) is one strategic approach that helps scripts drive problem-solving. Additionally, scripts can help maintain consistency and quality among outsourced vendors

How Authenticx Helps Guide Health Insurance Call Center Scripts

Med City News shared how big tech is now in a favorable position to help healthcare and insurance providers better leverage their consumer relationships to improve health insurance scripts. There’s an extensive pool of data to be utilized in order to help improve customer service and care. Listening at scale enables conversations to drive initiatives of brand loyalty, quality control, and process efficiencies – which can be strategically used to improve call scripts and agent effectiveness. 

This intentionality on call center scripts sees more positive outcomes related to social determinants of health (SDOH). A 2022 National Library of Medicine Study cited that incorporating scripts across the organization helped increase cultural proficiency levels, which led to a decrease in health disparities caused by SDOH.  

Authenticx is a software that connects qualitative human emotion to quantitative metrics by identifying root causes that are currently being captured in your contact center conversations. 

Tell Me More About How Authenticx Works with Contact Center Leaders

Contact center leaders need to feel confident their scripts are effectively equipping their employees and customers. Particularly across healthcare, there’s a critical need to identify barriers so processes can be improved and questions answered concisely and accurately. Authenticx was founded to surface meaningful insights from unstructured data. We help leaders strategically invest to optimize their quality assurance metrics to improve customer experience and operational effectiveness. 

Our platform  provides automated evaluations that review audio and metadata obtained from Interactive Voice Response (IVR) systems. With fully configurable options, Authenticx offers a healthcare-specific quality solution.  

Authenticx Request a Demo | Healthcare AI Solution

About Authenticx

Authenticx was founded to analyze and activate customer interaction data at scale. Why? We wanted to reveal transformational opportunities in healthcare. We are on a mission to help humans understand humans. With a combined 100+ years of leadership experience in pharma, payer, and healthcare organizations, we know first-hand the challenges and opportunities that our clients face because we’ve been in your shoes.

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