Member and Provider Call Center Services
Valence maintains an optional, full-service member and provider call center. Over 90 percent of call center staff is bilingual in English/Spanish, and Valence utilizes a contracted language line service line to accommodate callers in languages other than Spanish.
Call Center Services are conducted in a secure environment, and all call center staff members receive ongoing training, which can include specific topics, client programs, policies and procedures of the department, confidentiality and HIPAA requirements, cultural competency, and compliance.
Inbound Call Center Services.
Inbound customer service representatives assist members and providers with a multitude of common inquiries including: primary care physician selection, claims and benefit interpretation, as well as general questions about the health plan.
To ensure accurate and timely responses to in-coming calls, Valence provides staff with real-time access to the applicable applications and sub-systems that are needed to, for example, update member demographic data, check claim status, and provide benefit information.
Our Integrated Voice Response (IVR) telephony technology gives providers access to a member’s eligibility status, primary care provider and co-pay information – and can rapidly link the provider to a live representative for additional assistance.
Member Outreach.
Valence can assist in creating as well as implementing call center outreach programs that are highly efficient and effective. Our bilingual staff contact members for multiple support campaigns including, but not limited to, preventative care, treatment compliance, and re-enrollment. In addition, a Valence progressive dialer program can deliver customized messages to welcome new members, offer wellness reminders, or share any other health educational information that the health plan believes appropriate. Detailed reports on all outbound programs enable administrators and medical staff to track member contact, target populations for follow-up, or spot a trend within the population.
Valence Call Center Technology
To efficiently perform their work, call center representatives access a Valence-developed application that indicates services younger members of the health plan need to receive based on the pediatric periodicity schedule. By comparing paid claims data with the pediatric periodicity schedule, the call center representative is able to have an informed conversation with the member’s guardian. Specially trained outbound call center representatives are able to contact members to inform and educate them on health issues and plan benefits– including initiating three-way calls with providers for scheduling appointments. Although this technology solution was developed for a specific need, its architecture can be replicated to other defined medical situations at the health plan’s election.