Four Best Practices for Insurance Call Center Compliance


This post is part of a series sponsored by AgentSync.

Call centers don’t typically have the best reputation among customers in any industry. But, when executed well (or at least without long holds characterized by elevator music so loud it leaves you wondering if you’ve sustained permanent hearing loss), they can provide a valuable connection between a consumer and a business.

In an industry as saturated as insurance, great customer service can be a key competitive advantage that directly impacts a business’s success and growth. But the heavily regulated space means that insurance call center success is just as much about compliance as it is about superb customer experience.

What do insurance call centers do?

The main function of insurance call centers is to field customer questions. An existing customer might call in with questions about their current policy or to inquire about switching or extending their coverage. If a customer has a complaint or is experiencing any issues, a customer service representative (CSR) working at the call center can recommend a solution.

However, it’s important to understand that the questions a CSR can answer and the topics they can discuss with consumers depend on whether or not they’re licensed.

Do insurance customer service representatives need a license?

The short answer is no. Being licensed isn’t a requirement for becoming an insurance CSR, but licensure (or lack thereof) does dictate what a CSR is and isn’t able to do and discuss. We’ve covered the differences in greater detail here, but in simple terms, without a valid license, a CSR’s responsibilities are limited mainly to administrative duties. With a license, CSRs can discuss more detailed information with clients such as pricing and coverage gaps.

Call center compliance factors

Licensed CSRs deal heavily in highly sensitive consumer information, which is why call centers in the U.S. are held to several standards and regulations. You’ve likely heard of the Health Insurance Portability and Accountability Act, better known as HIPAA, which dictates how consumer health information is handled or the Do Not Call Registry, a list maintained by the Federal Trade Commission that allows individuals to opt out of telemarketing calls.

Other regulatory standards call centers in the U.S. must comply with include:

  1. The Telephone Consumer Protection Act: A federal law that requires consumers to give consent before someone makes telemarketing calls to them and sets limits on the use of pre-recorded messages and automated dialing systems.
  2. The Gramm-Leach-Bliley Act: A federal law that regulates the privacy and security of a consumer’s personal and financial information.
  3. The Payment Card Industry Data Security Standard: A set of rules mandated by credit card companies to ensure security in credit card transactions.

It’s essential that call centers comply with these standards, among many others to safeguard consumer privacy and reduce their risk of a data breach.

Keeping up with ever-changing regulations

If you follow along with our Regulatory Roundup series, you know how often regulatory changes and updates occur in the insurance industry. Not only do call centers need to stay up-to-date with current standards, they also need to be aware of any changes, additions, and updates to existing guidelines.

For example, the Centers for Medicare and Medicaid Services (CMS) updates their communications and marketing guidelines annually, but also issues important updates throughout the year.

A recent update to CMS guidelines directly impacts insurance call centers. The new guidelines state that all calls with customers who wish to discuss Medicare Advantage and Part D prescription drug plans must be recorded and stored for a minimum of ten years. Additionally, CSRs must communicate the required disclaimer language to the consumer within the first minute of a call.

What’s the risk of insurance call center noncompliance?

CSRs who fail to comply with new and existing regulations face repercussions. Not only can noncompliance result in fines and license revocation, but it also opens a call center up to greater security risks.

A call center that fails to keep up with the latest security regulations faces a higher chance of a data breach. If a breach does occur, and sensitive consumer information is leaked, the call center, and the insurer(s) it represents, will likely incur significant reputational damage and legal backlash.

Four insurance call center compliance best practices

1. Perform regular audits

Call center compliance audits are key to identifying areas of a business that are in compliance as well as any items that need to be addressed. A company may choose to perform audits on a monthly, quarterly, or annual basis, but it’s a good rule of thumb to also perform an audit whenever there’s a change, like taking on new business, adopting new technology, or implementing new regulations.

And performing a compliance audit is only half the battle; the rest is what you do with that information. It’s crucial that insurers create an action plan with the data they gather, and that they identify and perform the necessary steps to keep future operations compliant.

2. Always safeguard consumer data

Protecting consumer information should be a top priority at insurance call centers. There are hundreds of steps a business can take to safeguard their data. From something as simple as minimizing the number of employees with access to specific data to more involved processes like eliminating legacy systems with security vulnerabilities and replacing them with more modern technology.

3. Don’t let non-licensed CSRs answer questions that require licenses

We’ve touched on this already so we’ll keep this one brief. It’s crucial that insurance call center representatives know what they can and can’t do and say without a valid license – whether that’s a license to sell or one specific to servicing customers like a CISR. To avoid the consequences of noncompliance, plenty of insurance businesses have an entire team or department dedicated to ensuring all employees, including CSRs, are licensed agents. Of course, managing producer licensing can be quite the challenge without modern insurance licensing software like AgentSync to help.

4. Keep detailed records of all customer calls

Last on our list of call center compliance best practices is to always keep a “paper trail” of your calls with customers, in fact, in a lot of cases it’s even required to do so. Of course, we don’t mean actual paper. That’d be way too cumbersome.

Call recording technology like Gong allows users to capture all customer-facing interactions and store them in a library for as long as needed. This is great news for any CSRs needing to remain compliant with the new Medicare communications guidelines we mentioned earlier.

Insurance call center compliance isn’t optional

Insurance call center compliance requirements aren’t there just to make CSRs’ jobs more complex. They exist first and foremost to protect consumers and their data. And an insurance carrier or agency that fails to keep up with call center compliance risks a lot more than fines and penalties. Their entire reputation is on the line.

If you’re looking to guarantee compliance across your entire organization, AgentSync can help you check valid producer licensing off your list. From your distribution force to your CSRs, our modern licensing compliance solution makes manual compliance management a thing of the past. Gain peace of mind, Contact us today.



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