Open Enrollment Success: Contact Center Preparedness and Automation


Every year, the term "Open Enrollment" instills fear into management teams and agents at contact centers across the United States. Despite awareness of its impending arrival, open enrollment continues to pose numerous challenges for contact centers nationwide.


What is Open Enrollment?

Open enrollment is a specific time period during which U.S. citizens can alter their current health plan or choose to enroll in a new one. This year, it takes place from November 1st to January 15th in most states (with a few variances). These health policies can include employer plans or government-sponsored programs, such as Medicare or the Affordable Care Act (often referred to as ‘Obamacare’).

Outside of this designated time period, individuals can only make changes to their existing policies if they experience a 'Qualifying Life Event,' which must fall into one of the following four categories:

  1. Loss of coverage, such as a change in employment status.
  2. Changes in circumstances within the household, like a marital status change.
  3. Relocation to a new residence.
  4. Other reasons, for example becoming a U.S. citizen.

Aside from the above exceptions, all residents have only this limited timeframe to research and decide on their health insurance policies for the forthcoming year. Consequently, this is when the contact centers of insurance companies typically experience a surge in inbound inquiries from confused and stressed individuals, especially as the period nears its conclusion in January.

Additionally, many of these insurance organizations have their contact center agents engage in outbound campaigning to drive participation rates in open enrollment. This further increases the surge in activity and queries regarding new enrollments or policy changes.


The Role of Contact Centers

To cope with the high demand during open enrollment, contact centers typically extend their hours of operation, often providing additional evening and weekend support. Agents are generally required to engage in the following tasks and activities during open enrollment:

  • Handling inbound inquiries: There’s a significant increase in inbound inquiries as individuals seek further information about their current plans, alternative options, premium costs, and enrollment deadlines. Agents may also assist customers by clarifying policy details, including coverage limits, copayments and deductibles.
  • Providing guidance and assistance: Many customers have questions about the differences between particular plans and how to determine which will best suit their specific needs. Agents can better assist individuals in making more informed decisions using scripts and reference materials.
  • Offering enrollment support: Many contact centers provide additional support to help individuals complete the enrollment process. This may involve guiding them on how to access and use online portals, offering technical assistance for issues, and ensuring that individuals correctly submit all requested information. Some also continue to provide paper forms as an alternative to online systems.
  • Providing multi-language support: In many states, contact centers offer multilingual support to better accommodate and assist individuals who prefer to communicate in languages other than English.


How Can Contact Centers Best Prepare?

As each of these activities can have a significant impact on the subsequent decisions made by a vast number of individuals, it is imperative that contact centers adequately prepare and resource themselves for this pivotal, annual time period. They should undertake the following practices to ensure that they are primed and ready for the forthcoming influx of inquiries:

  • Conduct comprehensive training: All contact center agents should undergo thorough training before the open enrollment period begins to ensure they possess accurate and up-to-date knowledge of benefit plans, regulations, restrictions, and even the enrollment process itself.
  • Develop well-crafted scripts: Management should create carefully crafted scripts based on the most common queries, and covering topics such as plan options, coverage, costs, and deadlines. Additionally, contact centers should establish a comprehensive knowledge base or resource library that agents can refer to during live calls.
  • Ensure technology readiness: Contact centers must verify that all their technology, software, and customer communication channels are operating optimally. This includes assessing legacy systems, ensuring that customer relationship management (CRM) systems are interacting seamlessly across all channels and are accurately recording information, and confirming that call routing processes have been updated and are functioning as required. It is also critical that contact centers conduct stringent load tests to ensure that they can continue to perform under peak traffic conditions; these tests will identify any maximum capacities and bottlenecks.
  • Verify all numbers connect: While many of these numbers experience limited use for the majority of the year, they must perform flawlessly when call volumes surge during open enrollment. This requires contact centers to validate a large inventory of toll-free numbers, often tailored to customers' specific locations (i.e. their respective state). Each of these individual contact numbers will need to be thoroughly tested and verified for connection and audio quality.
  • Validate messages and IVRs: In addition to testing numbers, it's essential to ensure that the opening message that plays when customers dial in aligns with the program or company department the caller is trying to reach. Given the frequent changes within the healthcare industry, ensuring the accuracy of this information can take even longer than validating that numbers are connecting. Manual validation often requires multiple calls, a process that is inefficient and burdensome on human resources. Contact centers also need to rigorously test that all IVR (Interactive Voice Response) systems and automated messaging are correctly guiding callers to the appropriate department or information, confirm the accuracy of the information they provide, and ensure they recognize expected voice prompts or DTMF tones.
  • Offer omnichannel support: Contact centers should ensure they employ omnichannel support, including phone calls, email, web chat, chatbot and social media, so that customers can reach them through their preferred method. Consistency in information and service quality must be seamlessly maintained across all channels. Additionally, contact centers should ensure that online self-service options, such as enrollment portals for policies, are user-friendly and capable of handling increased traffic.
  • Monitor performance metrics: Implement key performance indicators (KPIs) and metrics to track agent performance and productivity levels. These metrics may include call wait times, call resolution times, and customer satisfaction levels. By monitoring these metrics, management can swiftly identify the need to scale up resources during peak periods.
  • Develop contingency plans: Management must establish comprehensive contingency plans to address unexpected spikes in call volume, system outages, or other potential disruptions. This should always involve verifying the effectiveness of backup communication channels.
  • Communicate with customers: Contact centers should also use outbound campaigns to communicate relevant open enrollment information to customers proactively. In addition, they should work to educate customers about the benefits of utilizing online self-service options and provide detailed instructions on how to do so. These measures alone can be very effective at reducing the volume of inbound inquiries received by the contact center.
  • Gather customer feedback: Before, during, and after open enrollment, contact centers should actively collect, document, analyze and understand voice of the customer (VoC) feedback. This enables management to more promptly identify areas for improvement and address any recurring issues efficiently. These insights can also be used to refine agent processes and scripts for future open enrollment periods.


The Need for Automation

Contact centers play an essential role in providing U.S. citizens with the information and assistance they require to make well-informed decisions and successfully enroll in health insurance or employee benefits packages. However, it's imperative that they take several steps, including monitoring and quality assurance of their customer experience technology ecosystem, to ensure they can continually deliver the best possible service to their customers.

By automating the testing and monitoring of their number connectivity, audio quality, messages, chatbot responses and IVRs, contact center teams can more efficiently conduct tests across a multitude of areas far quicker than traditional, manual testing methods would allow.

At Cyara, we serve four of the top five health insurance companies in the U.S., so we fully understand the significance of open enrollment for both our customers and their end-consumers. As open enrollment approaches and contact centers intensify their preparations, they should remember that we are here to help. 

We can assist contact center teams to better prepare, rigorously assess and test their omnichannel systems, and evaluate every possible customer journey. This empowers contact centers to swiftly identify and proactively address issues without any adverse impacts on their customers.