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LEADING HEALTHCARE INSURER ENSURES A HEALTHY BUSINESS BY LISTENING TO CUSTOMERS

"We've improved agent performance. We've improved our call center's productivity. We've been able to gather a lot of business intelligence to help us make key decisions. And it's delivering those results from NICE Perform that helped us get there." Sharon Whitwam, Vice President of Members Services, WPS

Wisconsin Physician Service (WPS), a leading healthcare insurer and one of the few remaining 'not-for-profit' companies still in health insurance, is using NICE Perform to extract insights from interactions and achieve its goal of ensuring a healthy business by listening to customers. With nearly 115 million claims from all health insurance programs (private, Medicare, and U.S. Armed Forces Tricare service) and over four million calls every year, WPS has defined its mission as providing "health and life insurance and benefit plan administration to customers with service and value considered by our customers to be the very best."

Insight from interactions addresses critical business issues throughout the enterprise

WPS wanted to focus on and improve customer satisfaction. They realized that they could improve quality of service and preempt customer turnover by effectively identifying, understanding, and efficiently escalating customer issues.

On the one hand, there was the customer. If they could identify those customers who showed a high risk of choosing different coverage and treat them in real-time, this risk would be mitigated.

On the other hand, there was the agent. WPS was looking to better monitor and understand certain agent behaviors to be able to correlate them to customer reactions and decisions and, consequently, fine-tune procedures, guidelines and adherence thereto by all of their agents.

This is where NICE comes in. WPS decided to implement NICE Perform to gain new insights from customer interactions and track the behavior of agents. In particular, WPS focused on NICE Perform's unique content analysis capabilities which include word spotting and emotion detection.

For example, NICE Perform's capabilities for emotion detection can identify a customer expressing dissatisfaction almost in real-time. Once this call is flagged, it is queued and routed to a member of the management staff. The issue gets reviewed, the caller gets a call back, almost instantaneously, and that results in what Sharon Whitwam calls the "wow factor." Because the customer who may have hung up the phone call, contemplating changing coverage, suddenly finds WPS in a very responsive mode, they are able "to probably win that customer for life. And I can't put a price tag on that."

Insight from interactions addresses critical business issues throughout the enterprise

Whitwam's approach ("Start small, think big") has led to WPS reaping significant benefits from the implementation of NICE Perform virtually from Day One. WPS is currently using NICE Perform to record activities (voice and screens) for 325 agents in various departments in the company, including claims, sales and medical affairs.

By concentrating on specific projects and utilizing NICE's Consulting Services to help define business drivers and objectives, as well as creating appropriate queries, WPS is able to use insights from interactions in the contact center to help the whole organization.

NICE Perform preempts costly appeals
Every customer has the right to appeal a denied claim in order to request payment. By creating an appeals lexicon with NICE Perform, WPS is able to identify and focus on the most common medical procedures that typically get escalated for appeal and through preemptive action save the time and cost involved in processing such appeals.

For example, by utilizing NICE Perform's advanced content analytics for identifying the calls associated with a particular medical procedure, WPS can understand, by monitoring the pre-certification call, whether what the agent is communicating to the client may lead to an appeal, and then go back and retrain the agent on how to eliminate appeals exposure in the future.

Gaining insights from customer interactions for better product design

The Direct Sales Department is also benefiting from NICE Perform. They needed to understand from a strategic standpoint what the competitors were doing regarding product and pricing, and to get that information efficiently and quickly. By building a list of key words, such as competitor names, NICE Perform's speech analytics capabilities enabled WPS to compile information that illuminated the competitive landscape and provided details on pricing, features, and incentives that are being offered. This vital information helps WPS to make more informed decisions about product design and provide their customers with a more competitive offering.

About NICE Perform^TM
NICE Perform is a fully integrated suite of solutions that extracts critical business insight from customer interactions. It applies advanced interaction analytics to locate, tie in and help understand information that is normally dispersed and unworkable. NICE Perform brings meaning and value to the information contained in the thousands of customer interactions that come into a contact center every day. With capabilities such as speech recognition, emotion detection, customer feedback, and call flow analysis, NICE Perform enables decision makers in the contact center and throughout the enterprise to better understand and anticipate market and customer dynamics, make more informed business decisions, take immediate action to implement change, reduce risk and drive business performance.

For more information on NICE Perform, visit www.nice.com/products/multimedia/nice_perform.php.

Learn how your contact center can employ customer interaction analytics to reduce customer defections, cultivate loyalty, and upsell - and cut costs at the same time. Gartner Research Vice President Michael Maoz and Sharon Whitwam, vice president of member services, WPS, share their insights in this exclusive pre-recorded web cast: Implementing Customer Interaction Analytics. View this presentation here.