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Components of a Successful Health Exchange Call Center


By Eric Rubin President, Health Operations at MAXIMUS

Many Americans experienced challenges during the initial rollout of the Affordable Care Act (ACA), but leading into the second open enrollment period some noticeable changes have already been made to ensure a more effective and efficient enrollment process.  As a result of lessons learned, many best practices have been updated and implemented with the health insurance exchanges.

Even with technology improvements, call centers need to be ready

Technology woes were getting a lot of media coverage at this point last year. When Americans had trouble accessing health insurance information on exchange websites, they instinctively turned to the exchange call centers, which were tasked with assisting them in navigating the process of applying, understanding their health plan options and enrolling in health insurance. The exchanges have worked hard to fix previously existing technology issues and further enhance their online capabilities, but however well the technology works, what we learned during the first open enrollment period is that people will still likely seek the help of a human when navigating the health insurance enrollment or renewal process. The exchange call centers must be at the ready to help anyone who needs assistance.

Ensure robust and relevant training

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To ensure that consumers have a good call center experience, quality training is of the utmost importance.  In the second open enrollment period, we are tasked with servicing two primary populations—those who chose to sit on the sidelines during the first open enrollment period and those that didn’t know about it.  These are some of the hardest to reach individuals and therefore require an incredibly helpful and empathetic call center representative.

With enhanced training of staff on the ACA and the enrollment process and an acute awareness of the cultural and linguistic nuances, we ensure our representatives are more aware of the unique needs of these populations, which will in-turn help get them enrolled. We have also tailored several training programs for these populations, and in some cases have added refresher training courses to ensure call center staff are ready to assist any unique needs. By working closely with states to update, adjust and execute on timely and relevant staff trainings, we are equipping those tasked with helping citizens navigate the health care system do so in an informed and efficient manner.

Be prepared to scale

Scalability also plays an important role in ensuring call center success. While training provides the essential foundation, if call centers do not have the ability to flex in response to varying call volumes, citizens may have to deal with unreasonable wait times or may be unable to obtain the services they need. The same goes for equipment needs—in order to answer the influx of calls that open enrollment will bring, reliable phone systems and the supporting technology must be in place.

To ensure that staffing and technology scalability is possible, appropriate support services and management needs to be in place, in addition to a robust training department that can support the ramping up of new staff to support such scalability.

Engage in ongoing communication with your partners

Communication between navigators, assistors and brokers are very important in ensuring that Americans get the health coverage they need. In anticipation of the upcoming open enrollment period, we have put processes in place to strengthen the communications between our call centers and key individuals like brokers. In most state exchanges, call center staff cannot advise citizens on their health plan choices or make recommendations. As a result, call center staff often refer those questions to brokers, who can provide them with a more detailed perspective on each health plan’s benefits.

Without direct communication between call center staff and brokers regarding their role in the exchange process, citizens could be stuck in back-and-forth conversations, which could cause the coverage for them and their families to be delayed.  To prevent this from occurring, our call center representatives engage in ongoing communication with all individuals who use the exchange. Remaining informed and flexible is one key to ensuring that citizens are not only calling an effective call center, but that they have a positive experience and achieve the outcome of obtaining the health insurance coverage they need.

In the past open enrollment period, 7.3 million people signed up for Qualified Health Plans (QHPs) offered by the exchanges, paid their premiums, and got access to affordable health insurance coverage. With lessons learned and best practices updated, we can expand that reach even further during the next open enrollment period.

Eric Rubin’s Bio:

Mr. Rubin serves as President of Health Operations, where he oversees projects focused on ensuring citizens get access to healthcare across the United States. He currently oversees all operational, financial, and business development activities for his region. Mr. Rubin has more than 25 years of health and human services experience in the commercial, state and local marketplace.

At MAXIMUS, Mr. Rubin has been integral in delivering outstanding customer service and implementing best practices, focusing on eligibility and enrollment services, across a number of projects in the United States, including the Maryland Health Benefit Exchange (MHBE) and the District of Columbia’s Health Benefit Exchange (DC Health Link).

Before joining MAXIMUS, Mr. Rubin served as Chief Operating Officer of Policy Studies, Inc. (PSI), which was acquired by MAXIMUS in 2012.  He also served as President and Founder of Lee Consulting Group, which specialized in developing strategies and operational plans for indigent patient programs for biopharmaceutical and other healthcare companies. Mr. Rubin’s experience also includes developing innovative enrollment and eligibility programs like TogetherRx, which helped almost one million seniors enroll in a pre-Medicare Part D program. He holds a Bachelor of Science degree in Biochemistry and is a graduate of the Columbia University Executive Management Program with a focus on Health Sciences Marketing.

The Editorial Team at Healthcare Business Today is made up of skilled healthcare writers and experts, led by our managing editor, Daniel Casciato, who has over 25 years of experience in healthcare writing. Since 1998, we have produced compelling and informative content for numerous publications, establishing ourselves as a trusted resource for health and wellness information. We offer readers access to fresh health, medicine, science, and technology developments and the latest in patient news, emphasizing how these developments affect our lives.

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