Going the Extra Mile: The CHOICE Member Services Call Center

Marlin Collado-Dilone, Member Service Representative.

One newly enrolled CHOICE member called with questions about her benefits. The daughter of another member phoned to check on the status of medical supplies that had been ordered for her father. A third member dialed in to arrange regular visits from a home health aide. Handling these types of requests is all part of a typical day’s work for the 83 Member Services Representatives (MSRs) at the VNSNY CHOICE Member Services Call Center, as they field upward of 3,100 calls to the center’s hotline each day from CHOICE plan members and their families.

Tatiana Bedoya, Manager, Member Services.

Established in 2012, the center is the outward-looking “face” of CHOICE for the organization’s various product lines and other ancillary services. Its answer lines for the CHOICE Managed Long-Term Care (MLTC) and CHOICE SelectHealth plans are in operation 24/7, while the other CHOICE plans field calls during business hours of 8:00 a.m. to 8:00 p.m. on weekdays. (During off-hours and weekends, plan members can leave a voicemail that will be returned the next business day.)

Irene Ng, Member Service Representative.

“The most common topics we get calls about are members’ medical supplies, transportation, and obtaining authorization for medical procedures and home care services,” says Nancy Vitale, Vice President for Member Services and Operations Administration. The key to the center’s success, she adds, involves staying ahead of the curve through attentive quality control. All MSRs adhere to the same quality guidelines, which include greeting the caller, putting him or her at ease, apologizing for any problems that may have occurred, and working to resolve the issue at hand.

“Sometimes it’s not what you say but how you say it,” Nancy notes. “Demonstrating empathy needs to be a part of every call. Some of these folks don’t have anyone else to talk to—we might be the only person they have in their life besides their care manager and their doctor, and we want to establish a relationship based on trust.”

Patricia Baez, Member Service Representative.

Once the caller’s problem has been resolved, a representative from the center’s Member Experience team then follows up by calling the member to ensure that the issue was settled to their satisfaction. In addition to the Call Center’s dedicated representatives, its staff includes a committed management team with some of the highest employee engagement results within VNSNY CHOICE.

Milagros Lopez, who is now an enrollment coordinator, has been with VNSNY Member Services for a decade, and estimates that she’s personally handled 50,000 calls. She credits a large part of her success—and happiness—in her job to the agency’s thorough training program. “At first it can be a bit confusing and overwhelming,” she says. “But when I started, I received three days of classroom training and then ‘shadowed’ more experienced people before going solo.”

Milagros views her job as a cross between a detective and a healthcare provider. She loves being able to interact directly with members, and is dedicated to getting them the answers and results they want. “If I have to do some research to solve the problem, I always assure them I will call them back and that we’ll get it done,” she adds.

Since CHOICE serves a vulnerable population that tends to have multiple chronic conditions, resolving a member’s issue can sometimes require extra creativity. Milagros recalls one CHOICE member with diabetes and mild Alzheimer’s who was receiving dialysis. He kept forgetting that home supplies don’t auto-ship and that he had to call every month to reorder them. Sensing this could become an ongoing cycle, Milagros spoke to his home health aide and arranged for her to call in the monthly order instead, then noted this in the system to alert other MSRs. It was just another example of a Call Center representative going the extra mile for a CHOICE member—and helping to stay ahead of the curve.