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.
While often viewed as the “middlemen” whose primary responsibility is the processing of prescription drug transactions, PBMs can also play an important role in guiding workers’ comp stakeholders through the often-complicated workers’ comp system. And one place where this becomes very evident is through a PBM’s customer service center (CSC).
The CSC’s primary functions may include facilitating and/or expediting 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 to look for from your PBM’s customer service center:
1. 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. While strategies including automation and AI can certainly play a role in enhancing the customer experience, 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 for CSCs to set high standards for the speed of answering calls so that callers aren’t left waiting on hold for long periods, as well as incorporate these standards into Service Level Agreements (SLAs). According to Talkdesk, the average speed of answer in contact centers across various industries is 28 seconds, depending on the industry and its complexity.
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