Study and Re-creation of Established Phone Call Procedures

Having worked in health insurance for a decade, my current workplace had endless opportunities for a Capstone project.  As a team lead, the abundance of project to select was daunting, however choosing a topic that is both familiar and challenging was a task in itself.  My department has had a longstanding stigma against outbound calls, they are necessary for our jobs of maintaining provider databases and ensuring correct provider selection on claims – yet our call documents prove outdated and difficult to understand for new and tenured associates.  My project, in simple terms, was to review the current documentation and build a better process.  The importance of this document is that it is used by three teams within our stateside PPG (Provider Pend Group) department, as well as our offshore call team.  The call scripting document includes situations where phone calls are made to providers with suggested scripting to get the requisite answers.  Calls are made to providers from the PPG department when a claim or correspondence is received that is missing information such as rendering provider, or has information that does not match what is loaded in the system.  As this is a project at my regular job, it has since evolved into a large undertaking that I will be working on for months to come.  Project deliverables at this time are a completed call scripting document, proposed call documentation opportunities with corresponding process documents, and data analysis on current phone call metrics.  In the future I look forward to implementing the new scripting document into our process dictionary “Mentor”, and creating a new process for phone call documentation that utilizes new technology coming in August.  During this project I used new data retrieval and analysis techniques, worked with others outside of my department, and utilized associates within my department.  The situation was new to me as I had to coordinate with leadership to pull associates to help on the project, direct those associates in what was expected, present my findings to various leaders, and feel confident in my research and findings.

One wish I have is that I had challenged myself with going out of my comfort zone and not doing the project at my employer.  While I did learn from the experience and I feel I have accomplished all that I needed to, had I gone and found a site somewhere new I may have learned more.  While it’s great I was able to complete this project without much logistical challenges, it would have served me better had I sought more challenge.