Health Insurance Customer Service
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 and PowerPoint formats. You can customize it to fit your own organization, or simply use it to better understand Health Insurance Customer Services business processes.
Related KPIs : Abandonment Rate, Average Handle Time (AHT), Average Speed of Answer (ASA), Customer Service Satisfaction Rate, First Call Resolution (FCR) Rate
What is Health Insurance Customer Service?
he 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.
Download a Sample Health Insurance Customer Service
Frequently Asked Questions
Q: How do you create your Workflow Templates?
A: From real-world consulting engagements with Fortune 500 leaders. We’ve spent 25 years analyzing operations at hundreds of leading companies worldwide, documenting thousands of business processes at precise levels of detail. We’ve anonymized this data—drawn from millions of dollars’ worth of consulting assignments—and have made it available to you in easy-to-use templates at affordable OpsDog prices.
Q: What can a Workflow Template do for me?
A: Boost productivity, efficiency, and service levels! Broken business processes—marked by manual workarounds, downtime, and errors—are all too common. Many businesses write off this waste as “the cost of doing business.” But you know better than that! Simply select the OpsDog Workflow Template that best fits your situation, tweak it to your liking, and then use it to train employees, identify process improvements, inform an IT project, or re-design a workflow. That’s a lot of power in your hands, cheap!
Q: What’s in the box when I buy one?
A: Three handy versions, all in one zipped file. It’s yours to download immediately upon purchase, and includes your chosen Workflow Template in PDF format, plus Microsoft PowerPoint (which you can edit), and Visio (which you can also edit).
Q: Your download-able templates look great. But I need something custom. Can you help?
A: Heck yes. Our analysts would be happy to provide you with a more detailed Workflow Template than what we offer for instant download. We can also develop an entirely new, customized Workflow Template to fit your business; we specialize in this stuff and would love to help you! Simply email us (firstname.lastname@example.org) or call us at 866.650.2888 and one of our friendly professionals will be happy to answer all your questions.
Medical Claims Processing
This workflow template illustrates the process by which medical insurance claims are received, processed and approved/denied. Purchase and download this template in PDF, Visio (VSD) and Powe...
Type : Workflow Template
Process Participants : Claims Manager, Medical Claims Adjustor, Medical Claims Processor