Why has Surest's customer support team seen a 50% increase in calls related to prescription drug coverage in the last two weeks?

Introduction

The recent 50% increase in calls to Surest's customer support team regarding prescription drug coverage is a significant issue that requires immediate attention and a thorough root cause analysis. This surge in customer inquiries not only impacts our support team's efficiency but also suggests potential underlying problems with our prescription drug coverage or related processes. To address this challenge, I'll employ a systematic approach to identify, validate, and resolve the root cause while considering both short-term mitigation strategies and long-term improvements.

Step 1

Clarifying Questions (3 minutes)

• Looking at the timing, I'm thinking there might have been a recent change in our prescription drug coverage policy. Has there been any modification to our coverage terms or formulary in the past month?

Why it matters: Policy changes often lead to increased customer inquiries. Expected answer: Yes, there was a recent update to our formulary. Impact on approach: If confirmed, we'd focus on communication and transition strategies.

• Considering the scale of the increase, I'm wondering about our customer demographics. Have we seen any significant shifts in our customer base, particularly in age groups or health conditions?

Why it matters: Demographic changes could explain increased prescription-related inquiries. Expected answer: No major demographic shifts reported. Impact on approach: If no changes, we'd look more closely at internal factors or external market conditions.

• Given the specificity of the issue, I'm curious about our data granularity. Can we break down the types of prescription drug coverage questions customers are asking?

Why it matters: Understanding the nature of inquiries helps pinpoint specific problem areas. Expected answer: Yes, we have categorized data on inquiry types. Impact on approach: Detailed data would allow us to focus on the most problematic aspects of coverage.

• Thinking about potential system issues, has there been any recent update to our claims processing system or customer-facing prescription information portal?

Why it matters: Technical glitches could lead to confusion and increased support calls. Expected answer: A minor update was implemented two weeks ago. Impact on approach: If confirmed, we'd prioritize technical audit and potential rollback strategies.