Call Center Services

The vendor is required to provide off-site employee benefits call center services (call center services) for the agency member services division (MBS) during our open enrollment period (open enrollment during calendar year 2025 for plan year 2026 benefits will be October 1 through October 24, 2025).
- The primary goal of this RFP is to identify a call center services vendor to ensure a seamless, transparent, and timely service experience for members engaging with agency through MBS, particularly during the open enrollment period.
- Inbound calls
• Contractor will receive inbound calls solely from members based on their progression and selection(s) through the city’s interactive voice response (IVR) system and in accordance
• The contractor, contractor will ensure that a live, fully trained, customer service representative (CSR) will serve as the initial contact for all calls.
- Outbound calls
• Outbound calls made by contractor will be strictly limited to level 1 service area topics and may include calling back a member for whom level 1 service area needs required additional research and internal consultation by contractor.
- Call center support and agency MBS service levels
a. Level 1 services
1. Call answering
• The selected respondent must guarantee that all inbound calls answered by contractor from members shall be taken by a live operator employed by contractor.
2. Overview of services and responsibilities
• Level 1 services will include the provision of general and/or current-state member information, verification of member(s) current enrollment, documentation and payment status, the provision of benefit and enrollment information to members, and connecting members with other departments, benefit plans and resources.
3. High-speed internet connectivity
• The selected respondent will ensure their staff will utilize high-speed broadband internet connectivity (at least 30mbps each for download and upload) while providing services to city to ensure optimal call quality, the prevention of dropped calls, and the capability to quickly and consistently access and query data from city’s systems
4. Technical requirements
• Automatic call distribution (ACD)
• Voice mail
• Queuing and related features
• Customer service representatives (CSR) and supervisor connectivity / application software
• Technical support
• Security and reporting
• Integration of customer relationship management (CRM) and computer telephony (CT) if elected by city
• PeopleSoft access via chrome internet browser
• Salesforce access via chrome internet browser
• Content management system, including the installation of a thin client
• Cisco contact center via chrome internet browser in the event that dedicated access is required.
b. Level 2 services
• Full-time MBS staff will continue to provide members with level 1 services (depending on agency internal call volumes and /or in-person appointment calendars) and all level 2 complex administrative, transactional and analytical work.
• Level 2 services require analysis, collaboration and consultation with health plan and benefit vendors, internal agency staff from other agency divisions, and analysis of people & pay and the case management system (salesforce, PeopleSoft HCM), the enterprise content management system, as well as appeals, troubleshooting city systems and errors and case resolution.
c. Level 3 services
1. Training format
• Trainings between city and the selected respondent will be conducted remotely via microsoft teams (agency may permit a comparable video conference platform upon request by the selected respondent).
• As determined by agency, trainings will be provided directly by agency to the selected respondent's staff, project managers, and/or supervisors (train-the-trainer).
2. Training topics
• The selected respondent will ensure its assigned CSR staff (and any managers/supervisors) are fully trained on all relevant topics, including, but not limited to, city benefits, health insurance portability and accountability act [HIPAA] of 1996, pub. l. no. 104-191 compliance, data confidentiality and security, technology proficiency, script delivery, documentation, call escalation and transfers, verbal and written communication skills, conflict resolution, handling sensitive and/or urgent access to care situations, and quality expectations.
3. Call-center scripts
• Validating the member to protect their phi and following act guidance when someone calls on the member’s behalf;
• Confirm member’s demographic information;
• Confirm member’s dependent information;
• Remind members to update beneficiary for life insurance when applicable; and
• Remind members of the value of routine and annual appointments.
- Budget: $502,000
- Contract Period/Term: 1.5 Years
- Questions/Inquires Deadline: June 06, 2025