Out-of-Hours Member Support for a California Health Plan

Our client is a relatively new health insurance provider based in California that has recently begun offering Medicare plans for individuals aged 65 and older.

Our client faced significant operational challenges due to the stringent federal requirements governing Medicare support services.

Federal requirements stipulate that any insurance provider offering Medicare must be open to member support calls from 8am-8pm, Monday to Sunday.

This posed a problem for our client as they were struggling to find agents that were willing to work outside of normal 8am-5pm business hours. On top of this, they were already having difficulty meeting a service level of 80% during business hours. This combination risked damaging their CMS scores, jeopardizing their ability to sell Medicare plans.

As a result, the health plan sought external assistance to bridge this critical gap in its customer support infrastructure.

Harte Hanks stepped in and offered tailored support center services. From Monday to Friday we handle the client’s member care between 5pm and 8pm, as well as 8am-8pm on Saturdays and Sundays.

On top of this out-of-hours coverage, while our clients’ internal teams still struggle to achieve service levels of over 80% during standard office hours, ours have never dropped below 80%.

In fact, since the start of February 2024, our average service level is over 97%. This has impressed our client so much that we have begun handling their welcome calls for Medicare and Medi-Cal as well, ensuring that new and returning enrollees complete their onboarding process.