Customer Service Process Improvement

Business Issue:

This Large, East Coast Healthcare Payer needed to improve their overall customer experience and their First Call Resolution (FCR) score. The organization’s FCR scores were in the 50% – 55% range for both of their Customer Service locations, far short of their goal to exceed 75%. The organization’s challenges included inconsistencies in the approach to call handling and the level of service provided by each Customer Service Representative (CSR), due to differences in training, individual level of knowledge, and preferred individual work styles.

The purpose of the project was to develop an improved Servicing Model and a repeatable set of steps for handling each call type with the primary objectives of improving overall customer satisfaction, improving the organization’s FCR rate to > 75%, reducing inbound call volumes, reducing operating costs, and creating repeatable processes for the CSRs.


  • Conducted a detailed evaluation of the operating model through one-on-one interviews, observations, and data analysis, and reviewed the strengths and weaknesses of the current Customer Service operating model
  • Analyzed existing call handling metrics, including call volumes and other statistics, to determine root cause issues with FCR and call accuracy
  • Developed and implemented a new staffing model, metrics to serve as the core operational measurements for the department, and a new Call Handling Framework to guide CSRs through 90% of the call types


  • Improved levels of customer satisfaction and significantly improved FCR rates
  • Established a model to deliver a consistent, high level of customer service to every member, on every call,
    by every CSR
  • Increased awareness of the strategies and tactics that are needed to solve the customer’s problem, not just answer their question
  • Implemented live escalation support from an expanded team of Specialists to help solve customer issues
  • Improved customer satisfaction by providing options to the customer to increase their control of the timeframe of the issue resolution and communication where possible

Process Redesign for a customer service unit in a Large, East Coast Healthcare Payer

Let's Work Together

At Himes Consulting Group, we don’t believe we have all the answers. We know that the right solutions to improve your business come from conversation and collaboration. We have the experience to learn your business and partner with you to create process redesign programs that fit your team.