Call spikes are not a surprise in health insurance, especially during predictable periods such as open enrollment, premium due dates, and major policy updates. What is surprising is how often organizations treat spikes as one-off emergencies rather than predictable operational events.
A resilient contact center model assumes that surges will happen, then builds a repeatable approach to absorb them without degrading service or permanently increasing fixed headcount.
Below is a short five-step approach your organization can use as a baseline for handling call volume spikes, designed to help maintain service levels, control costs, and avoid permanently expanding in-house teams:
Step 1: Identify the spike patterns that matter
Most plans see spikes tied to:
- open enrollment and plan changes
- billing cycles and due dates
- provider directory and access issues
- ID cards, prior auth, and claim status questions
- large policy updates or program changes
Step 2: Build a surge playbook with triggers
At this stage, it helps to clearly define operational metrics such as ASA, or average speed of answer, so teams across functions are aligned on what signals a surge.
A surge playbook should define:
- triggers (queue depth, ASA, abandonment rate)
- staffing actions (cross-trained pools, overflow routing)
- message actions (IVR updates, proactive emails/SMS)
- escalation actions (rapid response for high-risk populations)
Step 3: Reduce demand with targeted self-service
Self-service is not deflection at all costs. It is giving members a faster path for simple tasks:
- payment questions and due dates
- PCP changes
- ID card reprint requests
- claim status updates
To work, self-service must be accurate, easy to find, and consistent with agent scripts.
Step 4: Improve routing and resolution, not just speed
For example, during premium due date spikes, routing billing questions directly to a trained billing subgroup can improve first contact resolution and reduce repeat calls.
During spikes, routing is often the difference between manageable and chaotic:
- route by intent, not only by member type
- give specialists the hardest issues
- use concise scripts for high-volume call drivers
- refresh knowledge articles daily during peak windows
Step 5: Measure what drives cost
After each spike, review these metrics in an operational retrospective or monthly performance review to identify root causes, validate what worked, and reduce the impact of future surges.
During spikes, track:
- top call drivers
- containment by channel
- repeat contact rate
- escalation volume
Solutions like HealthAxis’ AxisConnect can support this type of flexible service model with multi-channel capability and configuration-forward workflows. These capabilities allow teams to quickly adjust routing, messaging, and workflows, helping operational leaders consistently apply the five steps above during predictable surge windows. Learn more about AxisConnect today.
