Health Insurance Customer Service Strategy

Business Continuity

About the Engagement 

During the rollout of the Affordable Care Act, three co-branded health insurance companies were developed across three states: New Jersey, New York and Oregon. The business model and operating model leveraged by these companies outsourced front-office and back-office vendors – from sales and billing and enrollment, to claims and medical management. The insurance companies required strategic, analytical and facilitation support to help navigate critical issues with their shared business model. 

Business Problem 

The route of the business problem was the need for a common strategy; however, a strategy that supported differentiated leadership, independent implementation, and oversight for each company.  


One problem was the lack of a clear customer service strategy and operating model. The next challenge was technology considerations (e.g., Customer Relationship Management (CRM)) and whether this should be shared across vendors between the three companies, and the last challenge was a consideration of the customer life cycle, specifically customer transaction (engagement) and the impact this had to staffing for each company.   

Project Impacts and Outcomes 

The engagement team led and facilitated the three health insurance companies to develop a shared customer service strategy and operating model, providing clarity on the shared goals and objectives. From there, based on industry standards and enrollment estimates with sensitivity analysis – the team developed a comprehensive staffing model from sales to customer services. The result was that the engagement team launched the three co-branded health insurance companies with 12 outsourced call centers in 9 months, with a daily call volume of 10,000+ and 200,000 total members being served. The outsourced vendors had a shared understanding of the complex operating model for three separate but co-branded companies; the call centers and back office-maintained service levels agreements, and the staffing model estimations were accurate.  



Posted on

November 7, 2023