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Health Care Case Study

Case #3936: Operational and Service Improvement - Provider Call Center Operations

The statewide provider services unit of a multi-state Health Insurance Company was experiencing a severe degradation of service. An effort to trim costs on a corporate level left the local management of the provider services unit unable to staff for increased volume and attrition. Service levels became so degraded that over a five-month period call volume dropped 33% as providers abandoned the provider service center and began calling the company's subscriber services units. The diversion of calls to the subscriber unit had an equally degrading effect, as they were not staffed for the increased volume. Inventory levels and aging of non-phone activities reached unacceptable levels and began to create additional phone calls.

During the course of our engagement the service levels were brought into acceptable limits, the call volume that had abandoned the provider services center returned and the non-phone activities were brought under control.

While the service levels were improving the labor cost per call was reduced by $1.18. With an annual forecast of 1,250,000 calls, the reduction in cost per call represents a savings of approximately $4.5 million over a 3-year period.

Engagement Highlights

  • Industry:
  • Health Insurance
  • Client:
  • Multi-State Health Insurance Company
  • Provider Telephone Center
  • Assignment:
  • Reduce 11 Minutes Average Speed Of Answer To An Acceptable Level.
  • Reduce Abandon Rate From 34% To Less Than 5 %.
  • Eliminate 1100 Blocked Calls Daily.
  • Regain Control Of the Non-Phone Activities.
  • Add Additional Capacity of 25 to 30 Percent.
  • Approach:
  • Organizational Analysis
  • Detailed Process Mapping of Non Phone Activities
  • Rationalization of Resource Utilization
  • Redefine Roles and Responsibilities of Staff And Management
  • Implement 'Perfect Call' Best Practices to Reduce Total Talk Time
  • Quantify All 'Off-Phone' Activities and Remove Non-Value Added Functions
  • Conduct Skills Assessment of Entire Staff and Institute Cross Training to Maximize Flexibility
  • Fully Integrate Phone and Non -Phone Units to Maximize Utilization
  • Develop Excel-Based Scheduling Models Predictive of Daily Needs in 15-Minute Intervals
  • Implement Customer Service Telephone-Tiering System
  • Duration:
  • 12 weeks


  • Service Levels Were Improved Dramatically While Overall Cost Per Inquiry Was Reduced
  • The Average Speed of Answer Was Reduced from 11 Minutes to Approximately 30 Seconds.
  • The Abandon Rate Was Reduced from 34% to 2%.
  • Call Blockage Was Eliminated.
  • The Daily Call Volume Handled Was Increased from 3300 to 5300 Calls
  • The Cost Per Inquiry Was Reduced from $3.78 to $2.60, a Reduction of 31%

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