Customer Service

Our Customer Service center is dedicated to each client. That means our customer service representatives are knowledgeable about your health plan benefits and can give accurate, timely, personalized information to employees.

Each of our customer service representatives is trained to ensure world-class service. They know that dealing with health care issues can be stressful for employees and their families. That's why we have friendly, cooperative people answering calls. With information right at their fingertips, our call centers provide prompt attention.

Our call center inquiries are answered with unparalleled speed and efficiency. And we always strive to improve our service.

Performance Standards
 

Pinnacle sets aggressive performance standards in order to meet the needs of our clients and their employees.  Our customer service and claims processing departments adhere to the following guidelines for performance.

• 80% of claims processed within 14 days

• 95% of all claims processed within 30 days

• Claims dollar accuracy of 98%

• Claims benefit accuracy of 96%

Clients are provided with quarterly reports that track Pinnacle's performance in these areas. In addition, we conduct our own internal audits to ensure compliance with these performance standards.

Automated Call Distribution System
 
Pinnacle utilizes a Meridian phone system developed by Williams Communication Solutions. Several Fortune 500 companies use this state-of-the-art automated call distribution system to handle customer service inquiries quickly and efficiently.

Through our toll free number, (800) 649-9121, all calls are answered directly by an automated voice response system and routed to an English or a Spanish-speaking representative. Customer service representatives document all incoming calls online. This allows us to track calls by the type of service requested, duration, and frequency, and provide sophisticated reports to our clients.

You can also reach Pinnacle's Customer Service Department by e-mail.

Integration with Claims Processing System

Pinnacle's customer service system is integrated with our claims processing system. Each call documented by a customer service representative is now available in the system to be viewed by other customer service representatives as well as claims processing staff.

This access ensures that future calls from the same participant are handled professionally and efficiently by reviewing information from prior inquiries. This feature also allows our customer service representatives the ability to e-mail and forward information to other departments within the organization for additional handling and follow-up. Taking place in a paperless environment, this process yields a quick turnaround time and efficient resolutions to customer service calls.