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Effectively Utilizing Technology to Support Open Enrollment Peak Seasons

by Sivarama Rambhatla and Dr. Donald Searing, Sagility - February 1, 2023

Effectively Utilizing Technology to Support Open Enrollment Peak Seasons 

By Sivarama Rambhatla and Dr. Donald Searing 

The current labor shortage continues to create capacity issues for healthcare staffing, particularly in customer-facing roles. With the increase of telehealth caused by the COVID-19 pandemic and peak seasons around open enrollment for employee-sponsored group plans and Annual Enrollment for Medicare Advantage plans upon us, the number of calls payers and their contact centers receive has drastically risen above normal operations. 

During last year’s open enrollment period, 14.5 million people signed up for 2022 healthcare coverage through Affordable Care Act marketplaces, according to the Centers for Medicare and Medicaid Services. As a result, payers must augment staffing with autonomous technologies and shore up their staffing through seasonal hiring to adequately manage requests without disrupting customer experience. 

Impact of Pandemic on Staffing Shortages 

When the pandemic hit, many health plans transitioned call center agents to remote work, resulting in an employee/need imbalance like never before. This issue can, at times, be solved through outsourcing call volume to business process outsourcing (BPO) specialist call center companies, which takes the burden of sourcing local professionals off health plans and streamlines member experiences. However, Medicare, Medicaid, government-sponsored plans, and some unionized plans require calls to be managed only from the U.S. geography. In these cases, payers must manage seasonal fluctuations with two to three times the typical number of U.S.-based customer service agents, a feat in today’s recession. Service providers like Sagility, however, can manage this process and take the burden off of plans by operating steady U.S. call centers with flex staffing for peak seasons. 

At the beginning of COVID, Sagility transitioned more than 40,000 call center agents to remote work, with people in locations domestically and globally, with minimal or no disruption to day-to-day operations. This shift created some challenges around broadband technology access and the urgency of securely managing personal health information from home. Sagility worked closely with telecom/internet service providers and the local governments to ensure the connectivity with relevant bandwidth for agents within days of declaring the emergency. The key for moving the day-to-day operations to working from home with the right equipment was to ensure adequate security for sensitive client data using AI-based tools to monitor and safeguard security protocols.

For payers, the task of managing fluctuations in staffing is compounded by challenges posed by open enrollment and COVID-19, but service providers are equipped to help health plans effectively navigate these concerns. 

Prioritizing Member Satisfaction 

Consistently providing clear, accurate information to members and providers remains crucial for payer call centers, which can often be achieved through automation. According to Forrester Research, consumers are 64% more likely to stay with a healthcare plan if satisfied—with 84% of members advocating for their brand.

By augmenting staff with technologies like bots that can work autonomously, call centers can ensure they’re connecting callers with the correct agent faster, increasing overall customer satisfaction. Not only do these technologies make interactions quicker, but they can also allow the customer to effectively move through the entire process without an agent. These once time-consuming manual interactions between a user and an agent, can be streamlined through solutions such as virtual assistants, chat bots, intelligent interactive voice response (IVR), increasing the effective availability of services. 

These technologies can be supplemented with additional channels by routing calls through mobile apps, virtual assistants, and self-service portals for greater efficiency. For example, self-service portals serve as a common tool for facilitating communications between payers, providers, and members to help reduce call volume on both sides, ultimately improving customer satisfaction. If set up as separate initiatives or solutions, however, these tools can cause even more problems. Therefore, combining all solutions and automations into a unified cloud-hosted platform ensures that the experience for the end user is seamless regardless of which channels they engage through. Companies like Sagility are uniquely positioned to serve both the payer and provider in these situations.

Resource-constrained payers must harness technology like analytics, AI, and automation to help tackle peak seasons efficiently and cost-effectively. Value-oriented contact centers equipped with data and digital innovation can serve as a seamless extension of payers’ teams to effectively address member inquiries and improve satisfaction while driving down costs. Staff augmentation with technology and shoring up staffing through seasonal hiring has never been more critical in order to adequately manage requests without disruption to customer experience while increasing customer satisfaction scores. 


Sivarama “Siva” Rambhatla is a Senior Vice President and Head of Solutions at Sagility, a healthcare business process management firm. Siva is a proven leader in the healthcare and insurance domain with 27+ years of overall experience (20+ years in BPO) - in all lines of insurance (Life, P & C & health) with demonstrable experience in operations, including TPA services for life & health insurance, P & L, solutions design, transitions, and customer management. 

Don Searing Ph. D. is the Vice President of Product & Solutions Architecture at Sagility, a healthcare business process management firm. He works closely with payer and provider clients to uncover their pain points and understand their challenges, enabling the delivery team to provide a solution configured to best suit their needs. As an experienced technologist with an extensive background in healthcare, Don leveraged his knowledge of the health insurance sales and service. 


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