MHA 505 Week 5

The Problem: Customer Service Representatives not resolving issues on a first time call

Why is it happening?

1. Not properly trained: why is that?

2. Were only trained to handle minor issues: why is that?

3. Used to pushing complicated issues to other areas: why is that?

4. Leaving subscribers and providers on hold for long periods of time: why is that?

5. This in turns leaves claims inventory high with unresolved issues.

Action to take: Customer Service Representatives needs to be willing to be trained on complex issues to be able to help members/providers when they call in. Another action would be for the company to set up a number of different phone lines to certain claim representatives to help when a customer service rep has issues. This will reduce the number of calls customer service receives, no more holding times for members/providers, and will also reduce the inventory in claims.