How Health Insurance Providers can Maintain Compliance whilst still Delivering Positive Customer Experiences

Posted: 26 May 2023

In today’s world, providing quality customer service is essential for businesses to thrive; by XM Institute highlighted that 89% of companies with “significantly above average” customer experiences outperform their competitors financially. Providing high-quality customer service is particularly significant for health insurance providers, who are responsible for providing customers with policies for medical expenses that Medicare does not cover.

Contact centre agents are at the forefront of customer interactions and must be equipped with the right technology to deliver high-quality customer experiences. Health insurance providers exploring how to improve how they support their customers, satisfy compliance obligations and improve operational efficiencies need to ensure they select the right contact centre technology for their business needs.

In this article, we’ll explore the many advantages of Health Insurance providers implementing contact centre technology, the regulations to be aware of and how to effectively utilise a range of features to deliver positive customer experiences.

What is Contact Centre Software?

Contact centre technology enables health insurance providers to engage with their policyholders across multiple communication channels to conduct necessary business activities.

Firstly, let’s examine the legislation health insurance providers must be aware of and comply with.

Key Legislations that Impact the Way Health Insurance Providers Use, Manage and Store Customer Data

While call recordings can be instrumental in ensuring quality customer service, storing recordings involves protecting sensitive customer data. Any organisation storing call recordings needs to ensure they meet compliance requirements.

As a health insurance provider in Australia, you need to be aware of two pieces of legislation when it comes to using call recording software.

The Health Records and Information Privacy (HRIP) Act 2002 (NSW)

This law regulates the collection, use, and disclosure of health information. It aims to protect the privacy of individual’s health information and ensure that it is handled appropriately by health service providers within New South Wales.

The HRIP Act outlines various privacy principles that health insurance providers must follow when interacting with customers. Some of the fundamental principles include:

  • Collecting only necessary information: that is required for their business purposes – for example, a policyholder’s first name, last name, and Medicare number.
  • Providing a disclosure statement: to individuals so they are informed about collecting and using their health information. This statement also ensures individuals can consent to their personally identifiable data being used.
  • Ensuring accuracy: the personal and health information collected and stored is correct, up-to-date, and complete. To meet this principle, health insurance providers need to take appropriate measures, such as establishing policies and procedures for collecting and storing this information and ensuring contact centre staff are trained in this area.
  • Safeguarding information: by taking reasonable steps to protect the personal and health information collected to avoid the case of misuse, loss, unauthorised access, or any modification occurring. This includes classifying how the collected data will be used and stored, the individual’s rights under the HRIP Act, and how they can lodge a privacy complaint if they believe their privacy has been breached.
  • Offering access: to policyholders by notifying them of their right to access their personal and health information that the health insurance provider holds, and if necessary, request that it be corrected.

The Privacy Act 1988 (Cth)

Health insurance providers are subject to the Privacy Act 1988, which regulates how personal information should be handled and stored within Australia.

Under the Privacy Act, health insurance providers must comply with various privacy obligations when interacting with customers. These obligations include:

  • Collection: personal information must be necessary for their business functions and activities.
  • Data quality and security: involves taking reasonable steps to ensure that reason why the personal information they collect is transparently communicated to the individual and confirms all data is accurate, up-to-date, and complete. Organisations must also protect personal information from misuse, interference, loss, unauthorised access, or modification.
  • Being Open: Provide a clear and transparent privacy policy outlining how your organisation handles personal information.
  • Providing access: to their policyholders by executing the individual’s right to access and request the correction of their personal information held by health insurance providers.
  • Allow individuals to act anonymously: when interacting with your organisation, where possible. This removes the requirement for customers to provide their personally identifiable information if they do not wish to, helping to improve the customer experience.
  • Effectively manage complaints: ensuring a process is implemented for handling privacy complaints, i.e., responding to any complaint promptly and effectively.

ipSCAPE’s platform contains various features to help health insurance providers meet these legislative requirements. For example:

  • Emails can be sent to provide customers with their latest policy to sign to authorise the collection of their personal information.
  • Activating play announcements at the beginning of each call to disclose the organisation’s terms and conditions.

Now, let’s explore the key features of a cloud contact centre solution that health insurance providers can utilise to satisfy compliance obligations and deliver positive customer experience

1. Call Recording

Call recording software can be a valuable tool for health insurance providers who want to enhance customer service and meet compliance objectives. Utilising the call recording feature in your contact centre solution provides a range of business benefits, some include:

  • Using recorded calls within the Quality Assurance (QA) module: allows health insurance QA managers to monitor the quality of their customer interactions. Using a QA Module, managers can review recorded calls to assess staff performance and use scorecards to provide feedback. This can help to improve performance and ensure customers receive a consistently high level of service.
  • Training and Coaching: can be undertaken by playing call recordings to agents so managers can illustrate best practices, provide examples of effective communication, and explain how specific interactions could be improved. This helps ensure all staff members have the skills and knowledge needed to provide excellent customer service.
  • Resolving Disputes: can be managed by identifying why an issue with a customer occurred and assessing how to address it best and fix it. Storing call recordings ensures the organisation can provide evidence of all interactions between a customer in case a dispute eventuates further in the future.
  • Meeting Compliance Objectives: ensuring organisations retain customer interactions for the required period. Call recordings securely stored in a cloud environment can provide an easy way for health insurance providers to comply with relevant regulations and avoid penalties.

Call recording software is a crucial feature of contact centre technology that can assist in areas such as quality assurance, training to improve staff performance and meeting compliance objectives. As a result, using the call recording feature can help health insurance providers to deliver a high level of customer service, increase retention and build lasting relationships with their policyholders.

Tips to maintain compliance when using contact centre technology

To ensure your health insurance organisation adheres to the relevant laws and regulations when using call recording software, it’s essential to consider the following steps:

  • Disclose the call is being recorded: which can be achieved by leveraging a sound file feature that can be played at the beginning of a call through leveraging a Virtual Agent. This automates delivering the disclosure statement at the beginning of each call. On the other hand, a dialler manager can create a section in the agent’s script as a reminder to communicate the disclosure statement to the customer at the beginning of the call.
  • Ensure Privacy: securely storing customer data that authorized personnel can access only. Health insurance providers should have procedures in place to ensure that call recordings are handled in a way that protects the Privacy of the individuals involved.
  • Data retention: all call recordings should adhere to the policies relating to the retention and disposal of call recordings. A health insurance provider’s internal policies must comply with the relevant laws and regulations by ensuring that call recordings are retained for the required timeframe (the Australian Securities & Investments Commission (ASIC) requires organisations to keep records for seven years).
  • Provide Training: to ensure staff members involved in any call recordings tasks are aware of their legal responsibilities. Regular training and refresher courses should be provided to ensure that staff are up-to-date with the latest regulations and policies.

2. Quality Assurance (QA) Module

When call recording software is used with a QA module, managers are empowered to quickly identify any issues that may have occurred within the call. Health Insurance QA managers can regularly review calls to ensure all relevant policies, terms and conditions were communicated, supporting compliance objectives to be met.

With a QA module, managers can also use scorecards to evaluate agent performance. For example, ipSCAPE’s QA module enables contact centre managers to create QA questionnaires to evaluate customer agent conversations and produce a score. Based on this score, managers can optimise their agent’s performance by conducting tailored training sessions.

3. Interactive Voice Response (IVR)

An IVR (Interactive Voice Response) system is a routing tool that uses pre-recorded messages to direct callers to the appropriate department or specialist agent. An IVR can also be used to facilitate callers to access self-service and resolve their enquiry, i.e., finding out store opening hours, which alleviates the need to speak to a live agent.

Health Insurance providers can provide policyholders the option to renew and pay for their policy over the phone by integrating ipSCAPE Pay within the IVR. ipSCAPE Pay is a financial institution agnostic solution, enabling multiple payment gateways to be added to support growth objectives. Policyholders can pay for their policy using the IVR to self-serve and utilise the touch-tone keypad to input credit card details. As self-service is achieved, this reduces operational costs yet also accommodates health insurance policies to be paid out-of-business hours. 

An effective IVR solution can support health insurance providers to:

  • Decrease operational costs: the IVR system can enable self-service, allowing callers to resolve their enquiries, thereby reducing the number of calls that live agents handle.
  • Optimise operational efficiencies: by routing all calls to the correct department or agent, reducing average handling time.
  • Increase customer satisfaction: a sophisticated IVR system can reduce call wait times as callers are transferred to their desired department, increasing resolution rates and providing faster access to information.
  • Accept secure payments that meet PCI compliance standards: by using the IVR as a tool to allow policyholders to renew and pay for their policy over the phone.

     4. Call Routing

    Call routing enables callers to be directed to specific agents based on predefined criteria. Call routing can help increase first-call resolution rates and improve the overall output of contact centre agents as they receive calls that match their defined skillset, supporting customer queries to be resolved faster.

    Health Insurers can configure their Interactive Voice Response (IVR) to enable callers to select an option to be connected with a specific business department. Once a caller selects a particular option, they are routed to an agent within that department. For example, the IVR presents three options to the customer – choose 1 for policy renewal, select 2 for policy cancellation or select 3 for any other enquiries – if a customer selects 1, they will then be transferred to an agent that can assist them with renewing their health insurance policy. Without this routing functionality, the caller may be connected to a different department, requiring the caller to ask to be transferred to the department they wish to speak to. Effectively setting up call routing in the IVR supports policyholders to be connected with an agent that can handle and resolve their enquiry, which helps to deliver positive customer experiences.

    ipSCAPE’s solution can integrate with Customer Relationship Management (CRM) platforms to create more sophisticated call routing. This integration can be configured to identify specific caller characteristics, e.g., the type of policy or cover they hold, which can equip the agent with all the relevant information associated with the policyholder. Insights into call resolution rates and agent response times can be accessed through ipSCAPE’s reports and wallboards for managers to monitor and, if need be, to take action to improve customer experiences.

    Ultimately, by using advanced contact centre software such as ipSCAPE, health insurance providers can leverage features such as call recording, quality assurance, the IVR and call routing to maintain compliance and improve agent performance and customer experience. In a competitive industry, this can give your business a significant advantage, providing customers with the peace of mind that they’ll receive excellent service when interacting with your brand.


    Want to learn more about how ipSCAPE can help your health insurance organisation maintain compliance while providing exceptional customer experiences? ipSCAPE’s cloud contact centre solution is feature-rich and designed to empower health insurance providers to create positive customer experiences. The answer can enable organisations to streamline and automate customer service processes, ensure compliance, and make it easier for contact centre agents to resolve customer enquiries quickly and efficiently.

    ipSCAPE is a feature-rich, scalable cloud communication technology solution with advanced integration capabilities. We help businesses connect with their customers through multi-channel communications, including Voice, Web Chat, Email, SMS, IVR, and other emerging channels.