Navigating the world of workers’ compensation can be complicated – not just for injured workers, but for all stakeholders involved. Employers, pharmacies, healthcare providers, and claims representatives all have a stake in the claims process and may each have questions or concerns along the way. That’s one reason why Pharmacy Benefit Managers (PBMs) play such an important role.
PBMs guide workers’ comp stakeholders through the often-complicated workers’ comp system. And nowhere is this more evident than through a PBM’s customer service center (CSC). The CSC’s primary functions may include handling prior authorizations, updating injured worker profiles, locating participating pharmacies for injured workers, and answering general drug-related questions, among others.
A good CSC can create an exceptionally positive experience for customers, claims teams, and injured workers. Here are four best practices for your PBM’s customer service center:
- Responsiveness and Access: A CSC should be open 24/7/365 to answer calls, and real people should be answering the phone. The latter may seem obvious, but it’s a proven best practice. According to a 2018 survey by Sitel Group, about 70% of consumers would rather speak to a human customer service representative than a digital rep or chatbot.
It’s equally important to set high standards for the speed of answering calls so that callers aren’t left waiting on hold for long periods. According to Talkdesk, the average speed of answer in contact centers across various industries is 28 seconds. - Quality and Training: CSC personnel should be trained in house by the PBM using a formal certification process, and ongoing training should be provided. According to TechTarget, proper contact center agent training reduces turnover, increases ROI, improves customer and employee experiences, and ensures regulatory compliance.
In addition to training, a dedicated quality assurance (QA) team should monitor calls daily for quality control purposes. Coaching and feedback may occur real-time, depending on the urgency of the findings. It’s necessary to track all customer service and quality issues and report them out on a regular basis. - Empathy: CSC personnel should be kind, professional, and caring. That means displaying empathy, or the ability to understand and share the feelings of another person. According to Cogito’s 2019 State of Empathy in the Call Center Report, 96% of phone professionals believe empathy is important to being successful at their jobs.
For PBMs, empathy is especially crucial because CSC personnel may be talking to injured workers who are already frustrated, hurting, or confused. For an injured worker, speaking to someone who displays empathy for their unique situation can make a big difference. - Knowledge: CSC personnel should have a deep knowledge of the PBM’s customers, systems, and processes. This allows them to provide accurate information and navigate systems efficiently, ultimately translating to better customer service. After all, the top priority for most callers is to have their issues resolved quickly. It's also important to know when a caller’s issue needs to be escalated because it is beyond the scope of a CSC agent’s knowledge – and PBMs should have a process in place for such situations.
