Health Insurance Customer Service Process Workflow Template

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Overview: Health Insurance Customer Service Process Workflow Template

This workflow template illustrates the processing of inbound contacts (phone or email) from health insurance customers, or members, and the subsequent resolution of customer requests and/or issues. Purchase and download this template in PDF, Visio (VSD) and PowerPoint (PPT) formats. You can customize it to fit your own organization, or simply use it to better understand Health Insurance Customer Services business processes.

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Process Details and FAQ: Health Insurance Customer Service

What is Health Insurance Customer Service?

The Health Insurance Customer Service process involves coordination between health plan customers, customer service representatives and customer service specialists to field, understand and resolve customer issues or requests. This process includes inbound customer call and/or email processing, customer communication (to determine if they are a new or existing member and understand the nature of their request), issue resolution, escalation (if required), and any subsequent customer account adjustments.

Which KPIs, or metrics, are typically used to measure this process?

The following metrics are typically involved in Health Insurance Customer Service processes:

Which employees and/or departments are involved in this process?

The following parties are typically involved in Health Insurance Customer Service processes:

  • Health Plan Members (Customers)
  • Customer Service Representatives
  • Customer Service Specialists
  • Account Processing Staff

What is the purpose of these workflow templates?

Broken business processes pervade companies, large and small. Manual workarounds, downtime, errors and other waste is thought of as "the cost of doing business." Use our workflow templates as a starting point to document your own processes. Customize them to fit your business and add "call outs" for improvement opportunities.

How are these workflow templates created?

These workflow templates are the product of over 20 years of hands-on management consulting experience, as well as research performed by the OpsDog team. All of our workflows are mapped using the BPMN 2.0 specification.

How do I download a workflow template?

Simply click the "add to cart" button and follow the process to purchase and download this workflow template. You can use any major credit card, or a PayPal account, to pay. After you have completed the purchase, you will receive a link to immediately download the workflow template in PDF, Visio and PowerPoint formats. If you aren't a registered OpsDog user yet, create a free account! New users get $20 off of their first purchase.

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  • Workflow Template


    Health Insurance Customer Service

    - Instantly download files
    - Includes PDF, VSD, PPT file formats
    - Customize PowerPoint, Visio versions
    - Workflows mapped in BPMN 2.0


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