Customer Service Management

Crafting a Winning TPA Customer Service Management Strategy

9th, Jun 2023

Crafting a Winning TPA Customer Service Management Strategy

In the healthcare industry, customer service management for Third Party Administrators (TPAs) involves coordinating and managing activities and processes that support the delivery of high-quality customer service. This includes setting customer service goals and standards that align with the needs and expectations of patients, healthcare providers, and insurance carriers. It also involves recruiting and training customer service representatives to ensure they have the necessary skills and knowledge to provide excellent service. 

For TPAs, customer service management is a crucial function since they serve as intermediaries between payers, healthcare providers, and patients(policyholders). Exceptional customer service in healthcare can boost retention rates and improve business outcomes. 

In this blog post, you will learn how to enhance your TPA customer service management with our step-by-step guide, including actionable items and a checklist for optimum business growth. But first, let’s look at the consequences of poor customer service management in the healthcare industry.  

Consequences of Poor Customer Service Management in the Healthcare Industry

  • High customer churn rates due to poor service delivery and customer experience 
  • Negative word-of-mouth reviews and reputation damage lead to loss of business 
  • Reduced revenue due to lower customer satisfaction and loyalty 
  • Increased operational costs from customer complaints and service recovery efforts 
  • Inability to identify and address service gaps and opportunities for improvement 
  • Difficulty in attracting and retaining top talent due to poor work environment and lack of recognition for performance 
  • Limited ability to leverage technology for service delivery optimization and process streamlining 

Read more: Customer Service: The Single Biggest Shift in Healthcare 

Consequences of Poor Customer Service Management in the Healthcare Industry

Steps for Crafting a Winning TPA Customer Service Management Strategy 

In this section, we will discuss the steps that you can take to craft a winning TPA customer service management strategy. Let's dive in!   

Step 1: Identifying Customer Service Goals and Objectives 

To create a winning TPA customer service management strategy, you first need to identify your goals and objectives. Here are some actionable steps you can take to achieve this: 

A. Define your customer service vision

What do you want to achieve through your customer service? Define your short-term and long-term vision. For example: 

Long-term vision: To become the go-to TPA for self-insured employers seeking personalized and comprehensive employee benefits administration. 

Short-term vision: To increase customer satisfaction ratings by 20% within the next 12 months through improved communication and streamlined claims processing. 

B. Identify your customer service goals

What specific goals do you want to achieve in the next year or quarter? Once you zero down on these goals, define specific, measurable, achievable, relevant, and time-bound (SMART) objectives to achieve your goals.   
For instance, you may want to reduce the average time it takes to resolve a customer issue to 24 hours or increase the first-call resolution rate to 90%. 

C. Conduct customer research 

Gather feedback from your customers to identify their expectations, pain points, and preferences. Use customer surveys, focus groups, and social media listening to collect data from which one can derive valuable insights.  

Let's say that a TPA's vision is to become the most customer centric TPA in the industry. To achieve this, they may want to set a goal to improve customer satisfaction by 20% in the next year. To achieve this goal, one may set the following objectives:  

  • Take steps to increase the first-call resolution rate from 80% to 90% within the next six months. 
  • Aim to reduce the average time it takes to resolve a customer issue from 48 hours to 24 hours within the next three months. 
  • Implement a proactive outreach program to engage with customers who have not used your services in the past six months.  

Step 2: Identify and Set Benchmarks for Customer Service Standards 

A. Review industry best practices

Research industry best practices for customer service management in TPA firms. Identify what other TPAs in the industry are doing to deliver high-quality customer service. 

B. Establish service level agreements (SLAs)

Establish service level agreements (SLAs) with customers to define expectations for service delivery. SLAs can include response times, resolution times, and other metrics that will be used to measure and improve customer service. 

C. Develop a customer service training program

Develop a comprehensive customer service training program for all employees who interact with customers. The program should cover the TPA's customer service standards, communication skills, problem-solving techniques, and best practices for resolving customer issues. 

D. Implement a quality assurance program

Implement a quality assurance program to monitor and evaluate customer service interactions. Use the program to identify areas where employees need additional training and to recognize employees who are excelling in delivering high-quality customer service. 

Step 3: How to Empower Customer Service Representatives  

A. Recruitment and Training of Customer Service Representatives

  • Define the key skills and qualities required for the role of a customer service representative. 
  • Develop a comprehensive recruitment process to attract the right candidates for the role. 
  • Test the shortlisted candidates to assess their skills and knowledge. 
  • Hire candidates who possess the right skills and attitude for the job and a strong customer-centric mindset. 
  • Provide regular training sessions to keep the representatives up to date with industry trends and best practices.  

B. Providing Necessary Tools and Resources

  • Provide access to customer service software and technology tools to streamline customer interactions. 
  • Offer a knowledge base or a repository of frequently asked questions to quickly address customer inquiries. 
  • Allow representatives to escalate issues to higher-ups or other departments, if required. 
  • Provide customer service representatives with training to use the tools and resources effectively.  

C. Encouraging a Positive Work Environment

  • Foster a culture of open communication and feedback. 
  • Encourage a supportive and collaborative team environment. 
  • Empower representatives to make decisions to resolve customer issues. 
  • Offer incentives or rewards to motivate representatives to perform at their best. 
  • Conduct regular team-building activities to improve team morale.  

D. Recognizing and Rewarding Excellent Performance 

  • Set clear performance metrics and targets for customer service representatives. 
  • Provide regular feedback and evaluations to help representatives improve. 
  • Recognize representatives who perform well through public recognition or awards. 
  • Offer promotions or bonuses for representatives who consistently exceed targets. 
  • Celebrate team successes and milestones to create a positive work environment. 

Recognizing and Rewarding Excellent Performance

Step 4: How to Improve Performance  

A. Measuring Customer Satisfaction and Service Quality

  • Identify the key performance indicators (KPIs) for measuring customer satisfaction and service quality, such as response time, first call resolution rate, and customer retention rate. 
  • Use surveys, feedback forms, and customer reviews to collect data on customer satisfaction and service quality. 
  • Analyze the data to identify areas where customer satisfaction and service quality can be improved.  

B. Using Metrics to Monitor and Evaluate Performance

  • Establish a system for monitoring and evaluating performance based on the KPIs. 
  • Use tools such as dashboards and scorecards to track performance metrics in real-time. 
  • Share the metrics with customer service representatives and other stakeholders to ensure everyone is aware of performance expectations.  

C. Identifying Areas for Improvement and Implementing Changes

  • Regularly review performance metrics to identify areas for improvement. 
  • Conduct root cause analysis to determine the underlying reasons for poor performance. 
  • Implement changes to address the root causes and improve performance, such as providing additional training or changing processes. This is vital to enhance care management at large.  

Learn more about the 5 Core Principles of Care Management here 

Step 5: How to Integrate Technology  

A. Leveraging Technology to Streamline Customer Service Processes

  • Implement a customer relationship management (CRM) system to manage and track customer interactions, preferences, and history. 
  • Use chatbots and virtual assistants to handle common inquiries and provide immediate responses to customers. 
  • Integrate call routing and IVR (interactive voice response) systems to quickly direct customers to the appropriate representative and reduce wait times. 
  • Implement a ticketing system to track and manage customer issues and inquiries, ensuring that each is addressed in a timely and satisfactory manner.  

B. Utilizing Analytics and Big Data to Improve Service Delivery

  • Implement data analytics tools to gain insights into customer behavior and preferences, allowing for personalized service and product recommendations. 
  • Gather feedback and identify areas for improvement by utilizing customer feedback surveys and social media monitoring tools. 
  • Analyze customer service metrics such as average handling time, first call resolution rate, and customer satisfaction scores to measure and track performance over time. 
  • Use predictive analytics to anticipate customer needs and proactively provide solutions, improving the overall customer experience.  

C. Use of Self-Service and Automation

  • Implement self-service options such as a FAQ page, an online knowledge base, and customer forums to allow customers to find answers to their questions on their own. 
  • Provide customers with automated tools such as appointment scheduling and status updates to reduce the need for human interaction and improve efficiency. 
  • Use automation tools to handle routine tasks such as data entry and document processing, freeing up customer service representatives to focus on more complex customer inquiries. 
  • Implement mobile applications to allow customers to access services and information on-the-go, providing a seamless and convenient experience. 

The Bottom Line 

Crafting a winning TPA customer service management strategy requires a comprehensive approach that prioritizes customer needs and preferences. By following the steps outlined in this blog post, including identifying customer service goals and objectives, conducting customer research and surveys, identifying customer service standards, empowering customer service representatives, improving performance, and integrating technology, TPAs can deliver exceptional customer service that sets them apart from the competition. 

At Mirra Healthcare, we understand the importance of exceptional customer service in the healthcare industry. That's why we offer a range of innovative solutions, including our AI-powered real-time analytics & reporting, and smart claims processing. To take the first step towards better mental health, explore our Medicare in a Box solution at Mirra Healthcare. Get in touch with us today for a personalized consultation.  

The Bottom Line

Back to topBack to top

Reviews & Testimonials

"In 2021, Ultimate Health Plans (UHP) partnered with Mirra Health Care (Mirra) to develop a software platform to support processing Claims, Customer Service, Eligibility, Enrollment, Premium Billing, Encounter Processing and a Provider Portal for our Medicare Advantage Plans.

Mirra collaborated well with our operations and compliance teams to successfully design and implement a system that was innovative, efficient, and compliant with all Medicare and Florida Medicaid guidelines and requirements all within the scope of our required timeline.

We greatly benefitted from the Mirra Project Management Team’s regular communication with Stakeholders through monthly meetings and recurring weekly breakout-focused calls, which were geared towards troubleshooting and goal alignment. Mirra was able to quickly maneuver and adapt their systems to our needs, resulting in successful implementation and go-live. Mirra continues to support our compliant operation and growth in the ever-changing healthcare industry rapidly and effectively updating their systems with new Medicare and Florida Medicaid rates and guidelines to ensure seamless compliance and efficiency. I have absolutely no reservation in recommending their systems to any Payer searching for improvement in their operational efficiency."

NANCY GAREAUCEO of Ultimate Health Plans

Book Demo Today

Personalized Demo Tailored to Your Organization's Needs

We respect your privacy and do not sell or share your information with third parties. Please read our privacy policy here.