Advocating for members all day long 

Cost and coverage are health insurance variables that get a lot of attention from companies and their employees. But from the employee perspective, the value their employer-sponsored health plan brings often depends on the human factor: how responsive customer service is, how valued they feel as members and how easily they can get answers when they need them. 

Read more about a recent study on how a health plan with high customer satisfaction ratings can benefit you and your employees. 

People-first approach

“We’re not just here to answer phones,” said Tricia Fields, director of customer service for Arkansas Blue Cross and Blue Shield. “We want to transform the ways our members engage with their healthcare by giving concierge-level customer service. Our goal is always to make a meaningful difference in the quality of their life—or at least make their day better for having talked to us.” 

Often, employees first turn to their employer’s own human resources staff for help with their health insurance. But Arkansas Blue Cross employs teams of customer service representatives better equipped to help—people whose primary responsibility is to help members engage with their benefits in helpful, effective ways.  

She said Arkansas Blue Cross starts by hiring and training skilled, empathetic individuals who are motivated to help others. “It takes a special kind of person to be able to help people understand their health insurance coverage better, answer questions, listen to their concerns and help resolve their issues. To do this work, you have to have empathy, intelligence and the ability to listen and communicate complex information in ways people can absorb. Doing right by our members has to matter to you.”  

Fields said for many patients, navigating the details of their health insurance coverage can feel like trying to read a foreign language. “This is especially true when they’re contacting Arkansas Blue Cross during a stressful time such as a family member’s hospitalization or new diagnosis. We understand it can feel overwhelming to manage without help, so we have teams in place to do just that, to respond as benefits experts who are here to research their issues and solve problems.”  

More than buzzwords 

“In our industry, advocacy, navigation and engagement are increasingly important,” Fields said. “They really just mean we approach members with a mission of helping make this aspect of their lives easier. We give members accurate information, personalized education and exceptional guidance through their healthcare journey.” 

She said member advocacy starts with empowering customer service representatives to solve problems and make sure members feel supported, heard and valued. “We try to help members get the full value of their benefits, whether that’s sharing with them that they qualify for a diabetes management program at no extra cost to them, connecting them to our behavioral health team for problems their family is experiencing, helping them find an in-network provider near them who is accepting new patients or sorting out a complication with their billing.” 

Fields said Arkansas Blue Cross also excels at navigation, helping members make more informed choices about their care based on their insurance coverage. This can mean clarifying their plan benefits, locating a provider who speaks Spanish or helping them evaluate cost-effective treatment options.  

“Depending on the member’s plan, we have programs and tools that can give them more information about how to access the most clinically appropriate care for their particular condition,” she said. For instance, customer service representatives may connect a member in need to Arkansas Blue Cross social workers or case managers who can help them further navigate the health system to fill gaps in their resources or provide personalized health education and a care plan. 

Fields said Arkansas Blue Cross approaches member engagement proactively. Beyond having trained experts available when they call with questions, Arkansas Blue Cross provides communications and digital tools, from the Blueprint Portal website and app to targeted text or email campaigns to notify members of available programs or remind them of things like getting an annual flu shot. The team also is available to members through chat and secure messaging on Blueprint Portal and responds within one business day to messages left after hours.  

Proof of excellence

Fields is proud of her teams’ work. She said Arkansas Blue Cross patient satisfaction scores are consistently higher than competitors’ and rank among the highest in the Blue system nationally. “Our members can tell when they call that we’re listening and ready to help. Knowing they’re talking to someone who cares about them as a member can make all the difference in how satisfied they are with their company’s health plan. 

“It’s easy to feel lost in a confusing maze of medical and insurance terms and having either too much or too little information,” Fields said. “We are here to make all that information easier to process and less overwhelming. We always hope that members feel a little better after talking with us.”