The health insurance landscape is more complicated than ever with Affordable Care Act regulation complexities and the myriad of choices available on public and private insurance exchanges. Not only do employers and HR teams need assistance with the changing landscape, but their employees also need guidance as they become more involved as consumers in the insurance process.

One national brokerage firm is leading the charge in providing direct guidance to their clients and clients’ employees through a centralized call center system. Arthur J. Gallagher & Co. is adding to its call center services, previously only offered through its local offices, by introducing centralized national call centers as well. The four large centers will provide coverage for every time zone in the U.S. and provide advice to clients and their employees to answer questions about their benefits and needs. All four centers will use the same technology platform so each can function as back-up centers in case of natural disasters in any one region.

"Right now [this service] is being handled individually by different offices, but we want to make sure we have a consistent way to provide that level of support across the country and in multiple time zones,” explains Rick Strater, division vice president and national exchange practice leader, Arthur J. Gallagher & Co.

Right now, 20 people will work in each center, but this number will likely double as Gallagher absorbs local centers into the centralized ones. The firm decided to centralize the centers from its 160 U.S. offices because it was inefficient to have a single firm solely providing services and support to their clients. Hours will vary for each location, with the Seattle location having longer hours to be available to serve clients in Alaska and Hawaii.

 

‘Concierge service’     

“It’s really a concierge service as a call center” that can monitor quality control statistics, but focuses most on satisfaction levels from clients, says John Kelly, who is leading the charge to join technology and a consolidated methodology for the new call centers. In fact, 92% of the time, their call center professionals can resolve an issue on the first call. 

“We act as a concierge for employees who don’t always understand all their benefits issues, such as complex claims, eligibility and EOB problems that happen on a day-to-day basis,” says Kelly, the division vice president of corporate and administrative services at Arthur J. Gallagher & Co. “We’re providing a higher-touch option for a very old [concept]: helping employees." 

Further, for employees making benefits decisions on their exchange platforms, “there’s a wealth of information there and many people will be able to find what they need on the platform. But I think the needs of consumers are situational. There are times when they want to do their own research online and times when they want to pick up the phone and have a person guide them," says Strater.

More than ever, consumers will need more direct contact with benefit advisers and experienced professionals to guide their benefits decisions.

“Higher deductibles on medical plans will by itself require brokers to provide more support and guidance on how to utilize those benefits to their fullest advantage," says Strater. He adds that all brokers must “be prepared to meet their needs and that those needs will change over time.”

Strater believes increased consumerism is the greatest solution for managing industry insurance costs.

“Frankly, I think that’s the panacea,” says Strater of having online tools and expert guidance for support. “We want engaged consumers who ask the right questions and are helping to drive down the cost for themselves and in doing so will help drive down the cost for the rest of us."

 

Additional support

Gallagher offers two additional levels of support to employees. For technical questions surrounding their partnered insurance exchanges with Liazon, employees are routed to Liazon consultants. Additionally, for employees who already have benefits through Gallagher and have questions about how to utilize their benefits, they have contracted with ComPsych, which provides support for consumers to utilize benefits appropriately, such as administrative support for claims, EOB review, fee negotiations and so forth. They help individuals understand options underneath their health plan and provide clinical support. 

“It’s an integrated process because we strongly believe that it’s not only important for people to have an understanding of their benefits at the time that they’re enrolling or making changes, but that they can actually utilize those benefits more efficiently and effectively, which is why we’ve contracted with ComPsych to provide that level of service to employees," says Strater. 

Every employee has specific contact needs, which Gallagher recognizes, and their brokers hope they can cater to all preferences. All call center conversations can be stored electronically and virtually for agents across the country to reference. 

“We are providing far greater choice to employees through exchange platforms and terrific decision support for the exchange platform. We are giving them tools on the backend so we can help them with claims, EOB review, fee negotiations support for out-of-network care. The biggest challenge that all of us face as consumers is the transparency of the data. I need to know cost and quality in order to make an intelligent decision as a consumer," says Strater. 

In the future, they plan to expand call centers into Canada and Europe and to provide chat functionality for mobile devices and even video chat.

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