Problem

The complaints being filed were tied to a distinct set of high-risk scenarios that some agents were not consistently navigating well. Situations involving provider network checks, Medicaid eligibility, consent to change plans, and benefit changes required a higher level of clarity and decision-making.

While foundational training was already in place, some agents struggled to apply that knowledge consistently when conversations became more complex. The gaps showed up most in communication: incomplete explanations, missed steps, and misalignment between what members needed and what they were being told.

The goal was targeted reinforcement around the specific behaviors and communication points most closely tied to complaints, helping agents handle these interactions with greater confidence and accuracy.

Risks 

CTMs created ongoing risks for both members and the business.

Member Risks:

• Confusion around coverage, benefits, and enrollment decisions

• Financial stress caused by gaps in coverage

• Disruptions in care for members with complex health needs

Business Risks:

• Increased compliance risk tied to CMS-reported complaints

• Strain on relationships with carrier partners

• Loss of member trust and confidence

• Potential impact on future enrollments and long-term growth

Strategy 

To address the top CTMs, I designed a targeted learning strategy that combined focused agent training with manager-led reinforcement. 

Challenges 

• Pinpointing root-cause behaviors:
  CTMs did not always stem from a single action. In many cases, multiple behaviors, communication gaps, or process breakdowns contributed to a complaint, requiring close collaboration with stakeholders and subject matter experts to identify the most meaningful patterns and determine which actions to prioritize. 

• Designing for limited huddle time:
  Because these were sales agents, time away from the phone directly impacted earnings, so the solution needed to be concise, structured, and realistic.

To meet this constraint, I built the weekly training to be completed across multiple huddles rather than requiring a large block of time at once. Agents completed the eLearning during one huddle and the knowledge check during another. Managers then used the remaining huddles throughout the week to reinforce the topic through guided discussion, coaching, and FAQs from the toolkit.

Cross-Functional Collaboration 

• Strategy: Partnered on identifying the top CTM priorities, aligning on rollout timing, and ensuring the initiative addressed the business's most critical compliance risks.

• Subject Matter Experts: Collaborated to identify root-cause behaviors, validate content accuracy, and ensure guidance reflected compliant, real-world application.

• Sales Directors: Reviewed and signed off on content validity.

• Agent Managers: Participated in weekly calls to receive the Team Manager Toolkit, align on the eLearning focus, and prepare to reinforce key behaviors with their teams.

Technology 

• Articulate Rise: eLearnings and Team ManagerToolkit

• Canva: Scenario-based videos depicting CTM consequences.

Impact 

• The initial rollout was intentionally targeted to agents tied to the top identified CTMs, allowing the business to focus support where it was most needed while limiting time away from the phone. The program was later expanded to the broader agent population ahead of AEP, ensuring alignment on key CTM risk areas before the company's busiest enrollment season.

• Complaint volumes decreased following the rollout of the targeted training initiative.

• Created a learning strategy aligned to the behaviors and communication gaps driving the top CTMs for the business.

• Improved clarity and consistency in how agents approached high-risk enrollment scenarios.

• Shifted learning from a one-time training event to an ongoing, manager-led coaching model that extended reinforcement.