Member Service Practices

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The current plan of member service practices common with managed care companies a lot involved and contain a lot of critical practices for patients. It is also important for managed care companies to have leverage and accountability when it comes to member service practices. Managed care companies have to be practical, organized, and responsibility when it comes to member service plans. There is a strong need to address the common current member service plan associated with managed care companies. To critique and analysis the current member service plan practice with today’s managed care companies is worth mentioning the positive and negative about them. Member services have a lot of services, costs, and information surrounding them. It’s…show more content…
Furthermore, customer expectations increase as call centers and web portals have evolved, (Kean, Vile, & Smith, PowerPoint slide 12, 2015). Also, it’s critical for health plans to have accurate information to be traveled in multiple channels. If those channels don’t get opened, then it could lead to inaccuracy, system malfunction, and costly errors for the health system or hospital. The downfall of member services is the increased emphasis on customer services leads to pressure on IT, (Kean, Vile, & Smith, PowerPoint slide 12, 2015). It’s a lot of pressure for IT to get everything right, speedy, and working consistently as possible for member services. Another downfall is health plan members already have a challenging time navigating through the perplexing health care plans and understanding the material. For instance, some of the issues are benefit structures, confusion surrounding benefit networks, nature of claims explanation of benefit (EOB), and consumer directed health plans, (Orji, PowerPoint slide 1, 2015). As…show more content…
Member services fall into the health care delivery and administration, the area of concern for health care delivery are providers or health care facilities for assistance in receiving services or initiating grievances. The bad aspect for administration is the nonclinical concerns and issues of enrollment, access information, and resolving issues, (Orji, PowerPoint slide 6, 2015). These types of issues should be addressed timely and fixed appropriately by customer interactive centers. (CIC) was specifically designed by managed car companies to provide these services and to serve as a central operation vis-à-vis plan member need, concern, or issue. The useful aspect about (CIC) is they focus on service and communication. Additionally, they offer and supply a variety of services plan members need and they do in ways that allow understandable meaning and information. Member service plans have more advantages than disadvantages and it’s important they work closely with managed care companies to balance out issues, costs, and benefits for plan

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