Insights

A Managed Care Plan Transforms Its Member Services by Implementing Customer Relationship Management (CRM) Software

Health Plan engages T2C to improve call center operations through the design and implementation of CRM.

Background:

A managed Medicaid and Medicare Advantage plan sought to improve the member experience by implementing a Customer Relationship Management (CRM) platform and improving its call center operations. They engaged T2C to improve customer satisfaction and reduce operating costs through greater automation and more efficient call handling.

Challenges:

T2C worked with the client to evaluate which application best fit the needs of the growing organization and helped implement its chosen platform. The client lacked many documented business processes, and due to their large application suite, integrations with their current applications were fairly complicated. T2C worked diligently with client staff to ensure process design and redesign were conducted according to schedule and to assist with integration work.

Solution:

Top Tier was engaged from the beginning of the project and helped the client define the business case and success criteria and metrics, and designed and oversaw the change management program for the project.   T2C designed the program structure and governance approach and assisted program management with program and project oversight. T2C’s team facilitated direct capture of objective sessions with client Subject Matter Experts (SMEs) to document requirements, configured business rules in the customer engagement software, designed and redesigned processes and workflows, designed and implemented integrations with legacy systems, designed testing and training strategy and materials, and delivered end user training.

Value:

The client realized immediate benefits that included decreased call handling time and increased first-call resolution rate. The new system greatly reduced the number of applications previously accessed for data entry and storage of member information. Thus, both member and employee satisfaction were greatly increased. The client also saw a greater level of policy and process standardization and adherence.