Extending Care Beyond Office Hours: Strengthening Member Support for a California Health Plan

For a growing California-based health insurance provider, expanding into Medicare wasn’t just a business decision — it was a commitment to care for some of the state’s most vulnerable residents. But with that mission came a serious operational challenge.

Federal regulations require any insurer offering Medicare plans to be available for member support calls from 8 a.m. to 8 p.m., seven days a week. For a newer health plan still establishing its member services infrastructure, this requirement quickly became a breaking point.

Their in-house team struggled to maintain coverage outside standard business hours, and even during the day, they were falling short of the 80% service level benchmark. Every missed call risked more than frustration — it risked compliance issues, lower CMS scores, and ultimately, their ability to serve Medicare members at all.

They needed a partner who could step in quickly, scale with empathy, and protect both their compliance — and their reputation.

Harte Hanks built a tailored after-hours support solution designed not just to meet regulations, but to redefine what reliable member service looks like.

1. Covering the Gaps That Mattered Most

We extended the client’s operating hours by taking over member care from 5 p.m. to 8 p.m., Monday through Friday, and providing full 8 a.m. to 8 p.m. coverage on weekends. This allowed the health plan to maintain full compliance while giving members uninterrupted access to help when they needed it most.

2. Raising the Bar, Not Just Meeting It

While the client’s internal teams continued to hover below the 80% service level mark, Harte Hanks’ support never dipped below it — not once. Since February 2024, our average service level has exceeded 97%, with frequent peaks at 100% during high-volume periods.

3. Expanding the Relationship Through Excellence

The consistency and care we demonstrated didn’t go unnoticed. Impressed by the quality of member experience we delivered, the client entrusted us with additional welcome calls for Medicare and Medi-Cal members, ensuring new and returning enrollees began their coverage with confidence and clarity.

By filling a critical gap in coverage and raising service standards, Harte Hanks helped our client turn a compliance challenge into a competitive advantage:

• Service levels consistently exceeding 97%, with many periods achieving 100% performance.
• Full compliance with federal call availability requirements for Medicare member support.
• Expanded scope of responsibilities, reflecting client confidence in our quality and reliability.

Most importantly, members received what matters most — timely, compassionate support, even after traditional business hours. For a population that depends on clear communication and quick help, that reliability translates directly into trust.