Health Plan


One of the largest public health plans in the nation was in search of a customer service solution. A plan that would provide greater operational efficiencies, increased scalability and provide a reduction in operating costs to a core multilingual blended customer care program was required. The organization is a non-profit provider of government funded health insurance with over 600,000 members.

When the company approached Ansafone, another vendor was handling their customer service. They were experiencing a significant growth in membership and needed to partner with a company that had enhanced technology features to support their reporting requirements and complex member base. Their current provider could not provide the technology, real time reporting and script customization required for accomplishing their growth projections. Therefore, they chose to utilize our health insurance call center services to meet their expanding needs.

They decided to outsource several functions that included member enrollment questions, eligibility verification, authorizations, pharmacy assistance and claims information. The company needed a support system to maintain the best customer care for their diverse membership base. The solution needed to meet their requirements for multilingual capabilities, provide standardization, improve processes, reduce costs, increase scalability and be a HIPPA compliant organization.


In 2004, Ansafone launched the inbound/outbound blended program to support the health plan provider’s 600,000 members. The program consists of a combination of both dedicated and multilingual shared agents. Ansafone tailored their proprietary call center management process to take calls for the client’s access to care membership inquiries, manage call escalation of grievances, expedite appeals, document key aspects of call interactions, meet all service level requirements, provide confidentiality and HIPPA compliance and manage disaster recovery/redundancy efforts. They also provide the health plan provider with detailed real time reporting and recordings accessible via a web based portal.

The client chose to utilize Ansafone’s accessing care management technology that would mirror their internal operations to manage their members. This choice engaged Ansafone as a true extension of the client.

The outbound component includes managing numerous membership outreach strategies such as: welcome calls, membership retention, enrollment/eligibility campaigns, healthcare effectiveness data and information set (HEDIS) preventive care. Ansafone positively impacted the health plan provider’s HEDIS scores by implementing a campaign focused on specific HEDIS measures. This campaign management aided their members in gaining access to care.

Ansafone’s strength and experience is providing the appropriate staff for the corresponding program through its performance driven culture. Hiring the best talent in the industry achieves process improvement, operational efficiency and scalability. Ansafone finds the ideal customer service representatives through systematic skill profiling and extensive recruiting process. The customer service representatives possess a combination of customer service and problem solving skills designed to meet or exceed the needs of each program. Ansafone’s culture contributes to employee retention and lower training costs.

Ansafone conducts extensive customer service training specific to healthcare, member retention strategies and insurance claim mitigation services. Best practices are leveraged across all customer care programs, including script customization and problem solving techniques. Understanding key metrics helps drive the highest value.


The program was and is a continued success. Ansafone was able to meet the client’s volume and quality goals within the first 3 months of the program, well exceeding the six to nine months estimated by the client.

The shared agent model component of the program, created a savings on average of over 86% per call for the after-hours/weekend calls. The client was able to avoid paying fixed costs for dedicated agents that would have remained idle at times. The shared agent model also is especially effective for the multilingual aspect of this program, allowing for greater flexibility to support the Health Plan Providers’ diverse membership base.

Finally, by providing quality people and processes, that reduced talk time, hold times and after call work, the result was a lower average handle time. The reduced AHT not only saves the client money directly, but is also connected to the enhanced customer experience. Promptly and proactively generating pertinent information and responses for customers creates high customer satisfaction. Through this increased member satisfaction, Ansafone has maintained an 18% higher percentage of retained members on an annual basis over the in-house operation.

Overall, Ansafone has implemented a solution that is delivering greater efficiencies, quality and member satisfaction.

Ansafone’s cost per call for after hours and weekends = 86% less than in-house call center Ansafone = 18% higher retention rates over in-house call center