The role of relationship dynamics in health benefits success

In the employee health benefits business, the needs of clients and members vary greatly. But one truth remains constant: the power of relationships. Of course, you want to offer best-in-class health plan solutions. But it takes more than the plan itself to be competitive. Success in today’s market requires soft skills that build trust, create relationships, and ultimately, deliver an unmatched experience for clients, members and their families.

Elevating experiences starts with “us”

The success of health care and health benefits is dependent on relationships. If you’re looking to build client relations or drive member satisfaction, it all starts with the team leading the charge. Whether you’re working with a third-party administrator (TPA) for self-funded arrangements or a carrier for fully insured products, you need a partner who goes beyond the benefits to build trust and show commitment to a positive client and member experience. This is particularly crucial for clients offering a self-insured health plan, which comes with a great deal of flexibility, but also complexity. Not all TPAs are created equal, but those who shine at customer service often share some common threads and strategies:

• They are committed to employing team members who reflect their values.
• Collaboration is paramount. They tap into the collective knowledge of their team to accelerate answers and deliver better solutions for clients and members.
• They cultivate trust, accountability and a healthy culture through open, transparent communication. Mistakes happen — but their employees own up to them, fix them and learn from them.
• Anyone in a customer service role embraces an empathetic approach. Members who call in may be dealing with anything from a health emergency, to a frustrating chronic condition or devastating diagnosis and no one deserves to be judged by their worst day.

Setting clients up for success

No two clients are the same, and neither are their members’ needs. From a client services perspective, benefits administrators who connect with an employer on a personal level are more likely to fully understand their needs and be able to tailor health plan solutions accordingly. Whether it’s customizing benefits packages or implementing wellness initiatives, personalization is the key to enhancing value and member satisfaction. They must communicate regularly on plan utilization and trends, practice active listening when it comes to client issues, concerns and needs, illustrate industry expertise and thoroughly explain how different plans or strategies can help clients achieve their goals. A good TPA establishes a policy of openness with clients and continually nurtures their relationships.

For health plans to be most effective, employers and their employees need to understand the benefits and how to use them. Beyond open enrollment, employers must be able to communicate to their employees about the intricacies of the plans, any nuances that exist and encourage employees to use their benefits to get and stay healthy. Engaging and supporting employers in this process is the job of a TPA, and the best in the business leave no stone unturned. They should empower the client with education, tools and resources to help communicate with employees.

Helping members make sense of benefits

A TPA’s or insurer’s customer service team is crucial to educating members on their benefits and serves as an extension of the health plan. The customer service team must deliver precise, comprehensive information and leverage training and leadership skills to serve members. Customer service associates, or care navigators, are there to listen to members and serve as advocates to help guide them toward optimal health plan decisions. They also must be equipped and empowered to collaborate with relevant teams and resources to identify fast, prudent solutions.

Related: Discover the advantages of a TPA with integrated medical management services

But it’s about more than providing a resolution; quality customer service is defined by the ability to connect with individuals on a personal level, to understand their needs, and to provide solutions with empathy and care. Every interaction with a health plan member should be seen as an opportunity to make a positive impact, to alleviate concerns, and to navigate the complexities of health care with compassion.

The bottom line

Being a good steward of clients’ and their members’ time, money and needs builds trust and allows all of us to work together to promote better health outcomes. Today’s health benefits market is constantly evolving but one thing remains consistent from year to year, this business is a people business. To stand out from the crowd, you must connect with clients and members on a personal level to deliver solutions that get the job done. Cultivating strong, collaborative relationships through exceptional client and customer service can drive member engagement and ultimately influence the success of a health plan.

Charlene Zielinski is the Director, Client Services at Nova Healthcare Administrators, Inc. She leads a team of client service associates for Nova’s self-funded medical, dental, vision, COBRA and reimbursement clients.

Jerame DellaPenta is the Director, Service Delivery and Engagement at Nova Healthcare Administrators, Inc. He has more than 15 years of experience in FSA/HRA administration, medical benefits and banking.