CUSTOMER COMPLAINT HANDLING Manual 10/12/2014
Contents I.
Document Distribution & Version Control ............................................................................................ 2
II.
Overview of this document................................................................................................................... 3 A.
Purpose ............................................................................................................................................. 3
B.
Scope ................................................................................................................................................. 3
III.
Definition of a complaint and its importance to ADNIC ................................................................... 4
IV.
Process, Roles & Responsibilities ...................................................................................................... 5
A.
Channels for submitting a complaint ................................................................................................ 5
B.
Acknowledging and Recording the Complaint .................................................................................. 5
C.
Target Resolution Times ................................................................................................................... 5
V.
Escalation Procedure ............................................................................................................................ 7
VI.
Complaints Analysis and Key Performance Indicators ...................................................................... 7
VII.
Process Flowchart ............................................................................................................................. 9
VIII.
Tips on Reacting to a Complaining Customer ................................................................................. 10
IX.
Glossary of Terms............................................................................................................................ 12
A. X.
Feedback Type ................................................................................................................................ 12 Complaints TAT (Turn around Time) ................................................................................................... 13
A.
Line of Business Wise ...................................................................................................................... 13
B.
TAT for SAM Clients........................................................................................................................ 14
C.
Complaints – Priority types categorization ..................................................................................... 15
D.
Complaint Categories and Sub-Categories ..................................................................................... 16
ADNIC-RSK-04-01 Revision 2
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I.
Document Distribution & Version Control
Issue History: Rev. #
Date
Preparer
Reviewer & Approver
Status
Distribution Group
1
30-04-14
Sethu
Benjamin Graham
Approved
All ADNIC Users
2
12-10-14
Sethu
Benjamin Graham
Approved
All ADNIC Users
Amendments to Document Rev. #
Date
Page #
Description
2
12-10-2014
8
Updated CMP Process flow
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II.
Overview of this document
ADNIC serves corporate and retail customers not just directly, but through business partners as well (e.g. brokers, medical providers, vehicle repair shops, surveyors & loss adjusters, etc.). While complete care is taken to ensure high quality service delivery, there are occasions where a customer will not feel satisfied with the services or product provided. Due to the importance of commitment to customer service, this documented procedure, supported by appropriate tools, has been established to define the handling / management of customer complaints received by any individual, department, unit, branch in ADNIC.
A. Purpose The purpose of this document is to define a process to manage customer complaints received at various touch points and the roles and responsibility of the individuals with defined service level agreements from complaint articulation by the customer to complaint resolution by ADNIC. This document should help us achieve the below mentioned objective:
Enhancing the reputation of ADNIC, by improving customer confidence, loyalty and satisfaction.
Creating a mechanism for ADNIC to hear and understand what our customers are thinking about our products and services.
Addressing reported customer dissatisfaction, quickly, effectively and fairly.
Achieving a situation where our customer feels we have addressed their complaint. However, if he/she remains unsatisfied with the outcome of our efforts, to ensure that he/she is notified of their right to refer the matter to the appropriate authorities and regulators in the United Arab Emirates, as the case may be.
Utilizing the feedback from our customers as an opportunity to enhancing our procedures and introducing corrective actions to avoid re-occurrences of any problems identified.
B. Scope The scope of this document is to clearly define and outline the roles and responsibilities of individuals and the service level of each stage of the complaint process from the time a service request or a complaint is logged until resolution.
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In addition, it also covers how the data captured is used to draft corrective measures in operations to eliminate or avoid repeat complaints.
III.
Definition of a complaint and its importance to ADNIC
A complaint is any expression of dissatisfaction by a customer, potential customer or other business partner related to a service or product provided by ADNIC or on behalf of ADNIC by one of our business partners; this expression of dissatisfaction will require a response from ADNIC. Why do people complain? The aim of complaining is to get compensation (financial and/or non-financial) for adverse effects, or to change a criticized behavior. However, 70% of dissatisfied customers don’t complain – they just leave and tell others about the bad experience. Customers who have a positive experience when voicing a complaint, express more satisfaction and have a greater tendency to remain loyal. Common reasons for customers not complaining include:
They did not think they would be heard
They did not know how to complain or where to go to complain
They were not sure how to speak of the situation
They previously complained, and no outcome resulted
They were worried about repercussions on the employees responsible (i.e. job loss)
To prevent dissatisfied customers from leaving, ADNIC has established a complaint handling process and various channels to help the customer voice their concerns. Why are complaints important? Complaints should be considered as a second chance given to ADNIC by a customer, and not to be taken as a “bad thing”. Here are some of the reasons why complaints are important:
Complaints can stimulate improvement
Complaints can provide a window on systemic problems
Good complaints handling can defuse a crisis and increase customer loyalty and brand value
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Most unhappy customers don’t complain; they just leave and tell on average 10 people about the bad experience!
IV.
We want to encourage customers to complain to help us improve.
Process, Roles & Responsibilities
A. Channels for submitting a complaint There are multiple channels through which complaints can be received. Channel Phone Call Email (customer service/employee email) Website In Person Fax Mail
How to Handle User receiving the call to register it in Lotus Notes CMP User receiving the email to register it in Lotus Notes CMP Contact center to register in Lotus Notes CMP Customer service to provide complaint form to customer or register complaint directly in Lotus Notes CMP Fax to be sent to Contact Center for entry in Lotus Notes CMP Mail to be sent to Contact Center for entry in Lotus Notes CMP
The client may not necessarily want to complain, but may want to provide suggestions, or even compliments. In such cases, Feedback form would be provided to drop in suggestion box. Complaints and Suggestions remain valuable to ADNIC and its efforts in improving customer service. For definitions of “suggestions”, “complaints” and “compliment” please refer to glossary at the end of this document.
B. Acknowledging and Recording the Complaint Customers’ dissatisfaction will be acknowledged, recorded in the complaints management system (Lotus Notes Complaints Management Process “CMP”) and a reference number will be provided to the customer. The complaint will be registered in English language, If in Arabic, it will be translated to English and logged. The complaint should be well documented with relevant details (on the person/entity complaining, their contact information, the experience they had, the date it happened) in order to help ADNIC adequately address the client’s complaint, and to ensure all information is gathered for legal & regulatory purposes. Once the complaint is registered, notify the customer of the estimated time it will take for ADNIC to resolve the complaint. Target Turnaround Time (TAT) are provided in the next section.
C. Target Resolution Times The customer complaining is expressing a form of dissatisfaction. In order to avoid worsening the situation, ADNIC has established target turnaround times for resolving the complaint. It is essential that ADNIC-RSK-04-01 Revision 2
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Complaints are handled in a timely manner not only for the customer, but for regulators as well, who scrutinize the complaints management process (i.e. Insurance Authority, Health Authority).
1
2
Activity Description Customer can complain at various touch points and method: Call Center, HQ and Branches Front Desk (FD). E-mail, Letter, Fax Website Customer will be asked whether she/he would like to log a complaint. If no, close the case as a normal customer inquiry.
Target TAT As and when received
Customer
Contact Center/FD Admin/Fax room team
In case the complaint is received via fax it will be transferred to Ops to log the complaint 3
Log the complaint in the system (LOTUS NOTES CMP) and provide the complaint reference to the customer and advise that we will revert back to him/her with an “update at the earliest” and estimated time for resolution (within 10 working days)
4
Complaint will be sent to concerned department.
As and when received
6
7
8
9
If the complaint is not ADNIC or ADNIC business partner related then request will be closed and customer will be informed The concerned department / Branch shall study the complaint and take steps to resolve the complaint. If more facts/details are needed, System Should be Updated (Lotus Notes CMP) If the action needed to be taken is within the authority of the concerned Department Head they would take the action and Update the system (LOTUS NOTES CMP) A proper reply explaining ADNIC’s view and resolution (if required) would be communicated to Complaints coordinator by updating LOTUS NOTES CMP. Call Customer Back to communicate the complaint outcome/resolution. Keep him posted on the status of complaint in case its pending with relevant authorities
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Any ADNIC staff who received the complaint from the customer. Complaints Manager
Complaints related to branches will be sent to branch manager and deputy. 5
Responsibility
At the earliest
Complaints Manager Department/Branch Manager
As per defined TAT Department/Branch Manager Department/Branch Manager Complaint Owner / Contact Center
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10
11
Activity Description (Insurance, HAAD)
Target TAT
Responsibility
All complaints on appropriate resolution by owner, will be reviewed by the complaints manager (independent body which is part of Risk Management Department) prior to closure. Monthly report to CRO on complaints by TAT/Category, Out standing/Unresolved, validity.
On closure of complaints
Complaints Manager (RMD)
Monthly.
Complaints Manager (RMD)
D. Training The CMP (Complaints Management Process) application is a lotus notes based application which is accessible by all ADNIC staff. An overview of the CMP is provided in Induction training. A self explanatory document on how to register a complaint is circulated to all ADNIC staff and available in the Lotus Notes.
V.
Escalation Procedure
On delay in response from the complaint owner/handler to whom it is assigned, it will be escalated to the Head of the function for taking action as per the agreed Turn around Time (TAT).
VI.
Complaints Analysis and Key Performance Indicators
Complaint metrics will be measured on a monthly basis and communicated to Management via the Risk Management Dashboards. Any deviations from targets will be investigated and, as required, action plans will be developed to minimize recurrence. Performance Indicators to be monitored will be as follows: Key Performance Indicator Turnaround Time (TAT)
# of Open Complaints at month end # of repeat complaint
Satisfaction with complaint resolution
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Definition Number of days between complaint registration and closing dates # complaints still open at the end of a given month # of complaints about/dissatisfaction with a specific complaint that was already registered Level of satisfaction of the complaining party with the resolution of complaint. To be gathered after the complaint is flagged as “closed” by someone other than the individual
Target As per defined TAT, 80% of the time (subject to a large enough population size) Prioritize Closure
1 week from closure of complaint
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Complaint Validity (Medical Complaints)
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resolving the issue. Satisfaction will be categorized as Fully Satisfied-1, Largely satisfied-2, Largely unsatisfied-3 & Completely dissatisfied. For Medical complaints, the validity of the complaints will be classified as Validity-Denied, Validity - Fully Upheld , Validity – NA & Validity – Partially Upheld
1 week from closure of complaint
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VII.
Process Flowchart
VIII.
Tips on Reacting to a Complaining Customer 1. Understand complaints as a normal part of your job and as a change to reduce customer dissatisfaction and to ensure customer retention. 2. If the complaint is in person, look for a quiet location for the complaint conversation. Do not let other customers listen to the conversation. Offer the customer a seat. Address the customer by name. 3. Signal willingness to talk (“let us talk about this calmly”). Over the phone, keep a calm, composed and sympathetic tone. In person, use your gestures, eye contact, and body language to convey that you are paying close attention. 4. Offer an apology or at least regret that the customer has had a bad experience. Use the first-person form when formulating your responses. (“I am really sorry that you had this inconvenience” or “I apologize for the trouble caused”) 5. Listen carefully. Do not interrupt the complainant. Let her/him speak first without interruption even though she/he may bring up incorrect statements. 6. Conduct the conversation in a calm and courteous manner. Respond calmly to exaggerations and personal accusations. Respond to insults calmly and bring the conversation back to the factual level. Do not argue with the customer and do not engage in a power struggle. An argument with the customer is always won by the customer. 7. Take notes. The activity of writing down what she/he says demonstrates to the customer that you are taking the complaint seriously and encourages her/him to explain the circumstances more accurately. Furthermore, the notes are valuable in complaint handling and analysis. If over the phone, mention that you are making note of all the information they are giving. 8. Avoid immediate diagnoses and listen to all the information without confessing that you were at fault. 9. Ask questions regarding the complaint until the situation becomes completely clear. Pose questions in a courteous manner. (“Thanks for the information. One more thing I would like to know is …..”)
10. Put yourself in the customer’s place. (“I can easily imagine that you are annoyed”). Avoid wordings that increase the level of annoyance (“You are wrong!” or “But this is your fault!”). 11. If a mistake actually happened, do not blame a colleague, other departments, or the firm in general. 12. Initiate the handling of the complaint immediately, if within your scope of work and authority. 13. If a prompt solution is not possible, promise the customer that the case will be thoroughly reviewed and indicate how long it will take before she/he received a notice. Observe this deadline. If this is despite your best efforts not possible, inform the complainant in a timely manner and explain the reasons. 14. If you are not responsible or you cannot do anything, forward the complaint and see to it that the receipt and handling process is continued according to the customer’s wishes. 15. Conclude the conversation positively. (“I appreciate that you have brought this matter to our attention”). 16. Document the details of the complaint and escalate to the complaint manager. A well-documented complaint is critical for ADNIC to understand the situation and to ensure adequate documentation if the regulators (i.e. HAAD, Insurance Authority) request information.
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IX.
Glossary of Terms
A. Feedback Type Term Complaint
Suggestion Compliment
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Definition Expression of dissatisfaction, usually involving a request for immediate action from ADNIC to address the complaining party’s concern. It helps us understand where attention is needed to better function as a business and better serve our customers. Information provided on areas in which we can improve. It may not require an immediate action but needs to be analyzed to identify areas of improvement. Expression of satisfaction with an ADNIC product, service or how staff has dealt with a customer. It helps us understand what we do well and leverage it across other areas of the business.
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X.
Complaints TAT (Turn around Time)
A. Line of Business Wise Line of Business
Priority / Category P1
P2
P3
P4
Resolution TAT in working days Life & Medical
3
5
5
7
Motor
3
5
7
10
Property & Energy
5
10
Marine Hull & Cargo, Aviation & Aerospace
5
10
Engineering & Construction
5
10
Liabilities & Financial Lines
5
10
Operations
3
5
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B. TAT for SAM Clients Line of Business
Priority / Category Resolution TAT in working days
Life & Medical Motor
3 3 (IMC)
5 (Garage)
Property & Energy
5
Marine Hull & Cargo, Aviation & Aerospace
5
Engineering & Construction
5
Liabilities & Financial Lines
5
Operations
3
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C. Complaints – Priority types categorization Category
Priority
Platinum/VIP
P1
Gold
P2
Silver
P3
Bronze
P4
Note: 1. Color coding applicable for Motor & Medical only. 2
TAT starts on registering of complaint in lotus notes. TAT calculated on working days (8 AM4 PM)
3. TAT applicable for complaints within scope of ADNIC/Partners 4. Complaints requiring inputs from HAAD, Insurance Authorities and Brokers are not in control of ADNIC. However regular updates on the status of the complaint will be given to the client. 5. TAT (P1 & P2) of 3 and 5 days is applicable for: - Life & Medical (Medical Authorization & PBM approvals) complaints - Complaints from high priority clients /SAM clients
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D. Complaint Categories and Sub-Categories
Category Medical PBM Related
Medical Authorization/Card Rejection Communication
Definition Dissatisfaction with a business partner with which a client has interacted. Examples of business partners include medical providers (hospitals, pharmacies).Approval of PBM Dissatisfaction related to rejection/delays incurred in medical authorization. Rejection of ADNIC insurance card by Hospital/Pharmacy Dissatisfaction with any communication channel used by the client in an attempt to reach ADNIC, or dissatisfaction with the frequency/nature of ADNIC communications with the client.
Motor IMC / Garage related
Dissatisfaction related to Motor (IMC) or Garage related.
Quality of products/services offered
Dissatisfaction with the accuracy of information or documentation provided to a customer/business throughout any ADNIC process.
Sub-Categories Quality of service & products Professionalism Refusal to serve ADNIC client
Office condition & environment Office location & accessibility Office hours & timings Call quality Ease of accessing / reaching ADNIC Website - Ease of use Website - Content Website - Online payment Unwanted calls / messages / mailings Response to queries / requests / complaints Quotation (renewal or new business) Issuance of policy & related documents Issuance of invoice Endorsements Delay in vehicle release Claim acknowledgment Claim processing / settlement Issuance of refund / cheque from ADNIC
Response to queries / requests / complaints Quotation (renewal or new business) Policy & related documents Invoice Endorsements Medical authorizations Claim acknowledgment Claim processing / settlement Pharmacy approval (PBM)
Knowledge of ADNIC products and process
Dissatisfaction with other process/documentation related issues that are not due to errors/delays.
Behavior and Professionalism
Dissatisfaction with the level of service provided by ADNIC staff either due to the level of professionalism when interacting with the complaining party or level of knowledge of ADNIC products, services and processes. Dissatisfaction with various aspect of the products offered by ADNIC (including price, variety, benefits) or dissatisfaction with how a product was advertised.
Products
Timely Communication
Dissatisfaction related to communication
Claims Rejection Staff Availability
Dissatisfaction due to rejection of claims Dissatisfaction in availability of ADNIC staff
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Refund / cheque from ADNIC Methods of payment Pre-requisite / requirements for insurance eligibility Documentation requirements from customer Documentation requirements from providers Behavior & Professionalism Knowledge of ADNIC products & processes
Pricing Product Variety and/or Benefits Inaccurate product advertising Product Knowledge Channel of communication Language/Tone Response time Valid Reason for rejection Availability during office hours Timely response
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