I’m fed up with the number of offshore member service agents we have and the amount of escalations they are sending to my team. Is anyone else dealing with Ambetter member service agents that are clearly not based in the U.S.? They are adding to my team’s workload because everything is an escalation and they cannot address basic needs of members. How many more teams will be shipped overseas?
9 replies (most recent on top)
It’s all over the company. EBOS contracted all of these offshore people and now they don’t have enough work for them so they are forcing other areas to find work for them. They can’t make phone calls or work Medicare so they can only perform half the job. And what they can’t do they send back over to us to work. They fired the whole COB Xcelys team and sent all of that work offshore and made those folks train them before their last day.
It’s the most nerve wracking thing. No matter how many times you provide education they don’t stop.
My manager had double the claims audits pulled on me and a few others that I know of. Just trying to find an excuse for a PIP to be started. I noticed this the first month and had to ask repeatedly why. After 3months back to normal. Still didn’t get an answer, because they “didn’t know why”. My audits were all at 100%, just added to my stress and caused further burnout.
All I can say . . . TriWest Healthcare Alliance is hiring
Hopefully everything will go to sh--t and Centene will realize so much offshoreing is costing them in rework, as much as they are saving.
Yes. I am in grievance and appeals, and nearly every complaint is made worse by an offshore agent. Inquiries are escalated, and we are educating members on their benefits and cost-shares because the agents are not doing their job, and passing it off as a grievance. I don't blame them because you can't do your job when you are not trained to. I was told if they make one mistake, they are gone. Centene ships these jobs overseas to companies that legally harass and belittle their employees, and they do it for a lot less money. We are left to pick up the slack of their incompetence with quadruple the caseload and stress. Add to that the fact that anyone who knew how to do their job can no longer fix the issues or was laid off, and it is a complete disaster. I can't tell you how many times in a day we have to pull calls just to decipher what a member is complaining about. And oh, by the way, its usually their 5th call of the day, trying to find someone who doesn't hang up on them, put them on hold for over an hour or just plain gives wrong information. We are overturning details left and right due to inaccurate information on those calls. When does it end? I can't wait to get a new job and as far away from this money-grubbing, a-s-backward company as fast as I can. Somebody of authority needs to delve deeper into what is going on because the members are being harmed here.
Its not just Ambetter - its across the board in all administrative support departments. I am in claims operations and they are sending everything over to their "GLOBAL" team - which means contractors in India and who knows where else. They are constantly making errors and then sending escalations back to us to fix. Also they cannot process a claim to completion because Centene is too cheap to give them the resources & training (geared to address the language/competency barriers) that they need. Instead they are pricing claims using a different system with different contracts and then it gets audited and we here have to fix it and it counts against us - not them. Nothing like having to pick up the slack for my team members that sadly were let go (to be sure in the end they will most likely be grateful) but now we have tons of rework because of them. 7 years and at least in my department they have not made one change to correct processes to improve quality and it will never happen.
In NYS, I’ve noticed this and what’s even worse is the influx of wrong information being given to members.
So on top of the incorrect cases being sent to different Departments, now you also have to deal with angry ambetter members stuck with bills worth hundreds of dollars.
Why you may ask? Because these offshored agents are giving members the full wrong information, telling them that a prior authorization is not needed (when it fact they are). Telling them the services are covered 100% by us (when they aren’t), telling them that the services aren’t applied to their deductible. (When in fact they are).
For example). Had a woman in her 50s call and say she received a bill for approx 2500$ for a minor surgery.
Reviewed her case, reviewed the benefits, and found the case note- turns out the agent informed her the surgery would be covered by plan, no deductible, no copayment. (She’s on the bronze plan).
Obviously when the claim came in, we covered $67 (not even joking- wish I could add a screenshot). And the rest was applied to the deductible.
Not only was this woman crying and screaming on the phone when I informed her of this, when I called the associate support line- they simply said “that’s not our problem- she must pay.”
Even though we did inform her wrong info 🙂.
I genuinely hate this company. And am currently looking for other jobs. And best believe I warn EVERYONE to stay away from the NYS plan. Even providers.
It is far from done we have only begun. No more severance the company will make sure that those displaced will not get severance but will be bullied to.quick for their bottom line. UHG is truly evil and should be held accountable but they have billions behind them and are undeterred due to their size. Get ready for much more. Including Hostile work environment to get you to leave. In fact, they want employees to quit, it is on the record.