TPAs and automation, part 1: Humanizing customer service

Automation is great, except when it isn’t. Examples of the dark side include endless button pressing in automated phone trees that often conclude by yelling the word “operator” into the phone, and receiving form letters or emails containing incorrect, basic information. It’s no wonder the Aspect Customer Experience Index states that “nearly a third of consumers would rather clean a toilet than talk to customer service.”

Yet automation, when done well, remains a central tactic TPAs can deploy to gain competitive advantages in efficiency, accuracy, and resource allocation. When mismanaged, however, it can lead to impersonal service and damaged client relationships. The key to successful automation is to take advantage of technology’s benefits without losing the “human-centric” element. Kristin Smaby explores this concept in Being human is good business.

“In an era when companies see online support as a way to shield themselves from ‘costly’ interactions with their customers, it’s time to consider an entirely different approach: building human-centric customer service through great people and clever technology. So, get to know your customers. Humanize them. Humanize yourself. It’s worth it.”

In this three-part series we’ll examine how strategically balancing the human/automation mix can deliver a competitive advantage through:

  1. Improving customer service
  2. Enhancing employee retention/recruitment
  3. Boosting performance KPIs

Addressing these three initiatives from a human-centric perspective allows your organization to meet the personalized service expectations your clients demand, while gaining the productivity boosts smart automation delivers.

Improving customer service

Why TPA customer service matters

The McKinsey & Company article Improving the business-to-business customer experience highlights the untapped opportunities B2B businesses can find in transforming their customer experience. The authors note, “In cases where companies have undertaken broad transformations of their customer-experience processes, the impact among B2B and B2C players has been similar, with higher client-satisfaction scores, reductions of 10 to 20 percent in cost to serve, revenue growth of 10 to 15 percent, and an increase in employee satisfaction.”

The article also points to a gap of up to 35% in customer experience scores between typical B2B and B2C companies. “This gap will become even more apparent as B2B customer expectations rise,” the authors warn. The service options consumers experience each day are influencing expectations they place on B2B vendors in the workplace. TPAs that meet this new expectation will leave behind those who can’t.

Multiple customers to consider

TPAs serve not only the clients that contract for claims management, but also each individual interacting with the claims process. Clients and claimants have different needs, yet each can benefit from smart automation.

Claimants as “consumers”

As noted in The value of branding your claims process, “[C]laimants are your customers. Viewing claimants through this lens will help focus your efforts on strengthening relationships and delivering better support.”

Challenge: The rise of the self-sufficient consumer
The Aspect study reveals an increasing trend of consumers trying to become more self-sufficient in the customer service process. Not all businesses, however, are ready to meet that demand. Joe Gagnon, SVP and GM of Aspect’s Cloud Solutions said, “The average consumer interacts with customer service 65 times a year, yet they are increasingly underwhelmed with an experience that does not reflect consumers’ digital and mobile preference nor their desire to resolve issues on their own. This represents a tremendous missed opportunity for companies to build business and secure customer loyalty.”

Solution: Claimant app
Apps that let claimants view the process of their claim, such as the Origami Risk Mobile Claimant app, provide the efficiency benefits associated with automation along with the self-service and 24/7 access options consumers demand. By eliminating many of the “where do things stand” type of calls, adjusters are free to spend more time with claims requiring more attention.

Challenge: Aligning claim assignment with adjuster skills sets
Not all claims are the same just as not all adjusters are the same. When claims are matched with adjusters who are best equipped to handle them, service levels increase. A mismatch, on the other hand, can frustrate both claimant and adjuster, leading to uneven performance. Carefully managing queue assignments to ensure certain claims are handled by the right adjusters can be a resource drain, yet relying on random order assignments can lead to overwork for some adjusters and underutilization for others.

Solution: Automated smart assignment
Creating automated assignments based on workloads, regions, claim types, or any other combination of factors ensures that each claim gets routed to the best match of available adjusters. Senior adjusters work the more complex cases, while junior adjusters draw from a constantly replenished queue of simpler claims without overwhelming those with the most open claims. This not only eliminates the need to manually assign each claim, but also sets up each adjuster for success by directing them to the claims they are best equipped to handle. As Smaby notes, this can impact the customer experience as well. “[A]gent-customer relationships are not only encouraged but reinforced through preferred-agent routing mechanisms.”

Client-facing customer service

Attracting and retaining clients can depend, in part, on customer service and client communication.

Challenge: Presenting clients with a continuous message of the value of your services
In What causes B2B customers to churn? Three things, and price isn’t one of them, Christine Crandell writes, “Contrary to popular belief, customers do not purchase to solve a problem, they purchase to achieve an outcome.” Keeping each client aware, on an ongoing basis, of how your organization affects their bottom line (outcomes) can be a time-consuming and difficult-to-scale endeavour.

Solution: Robust push reporting
Origami Risk allows you to create dynamic reports, dashboards, and even PowerPoint reports that, once created, can run automatically on a scheduled basis, on demand, or when specified threshold triggers are met. This functionality puts critical information into the hands of all of your clients, without the need for your staff take the time to run a separate analysis for each. This allows you to demonstrate value in a scalable, targeted way.

Challenge: Meeting the self-service expectations arising from B2C customer experiences
The service score gap in the McKinsey article indicates how challenging it is to meet the rising customer service expectations of clients. Customer portals and 24/7 access to their data as consumers is influencing what they expect from vendors.

Solution: Client Portals
Online portals empowers clients with the ability to directly run the reports they need—on demand—and deliver the transparency that earns client trust and establishes credibility. As a bonus, each time clients access the portal and pull the information they need is one less request your staff must handle, freeing them up to work on higher value tasks.

Understanding how to meet the customer service needs of both claimants and clients can be challenging. The recent article The Transformation of the TPA speaks to just how difficult this transformation can be. According to the authors, “A recent Forrester and Accenture study found that, while 63 percent of businesses plan to improve their online customer experience, only 26 percent are actually prepared to execute those strategies.”

Technology like claimant apps, round-robin assignment, push reporting, and client portals can increase efficiency, while still allowing for the human-centric customer experience that builds client loyalty and differentiates your organization from competitors.


To find out how your organization can use smart automation to deliver next-level service to your clients, contact us to schedule a demo below.