Customer Service

PGBA's customer service stands apart, and recently became a Certified Center of Excellence, awarded by BenchmarkPortal. From clarifying plan benefits to researching medical procedures, more than 9 million plan members depend on our toll-free call center each year for detailed, yet easy-to-understand explanations to their questions.

The very heart of our customer service program is our people.  Our hundreds of customer service representatives possess those unique qualities that make them excellent at what they do.  Compassionate listening, excellent communication skills and empathy are required and we foster and support these qualities in each of our representatives.  Our all US citizen, security cleared and HIPAA compliant representatives are here for the sole purpose of taking care of our customerís needs. 

An interactive voice response system is the lead technology behind call center operations. This system allows us to answer more than 95% of all calls in less than 30 seconds, without putting a caller on hold. Combine this with a highly trained team of customer service representatives and desktop systems that immediately access caller and plan data, and the result is a call experience that has received satisfaction ratings unmatched by any of our industry peers.

Voice response unit (VRU)

PGBA's voice response unit allows callers to be routed to a customer service agent. Providers and plan members using telephone self-service can check the status of their claims, as well as verify eligibility and benefits. Given the wide variety of options in our VRU technology, we can meet the call routing needs of smaller plans with niche products to those with a large, well-established membership.

Computer telephony integration (CTI)

PGBA offers several advanced customer service solutions that fully integrate computer and telephone systems. For example, our systems can collect caller identification information at the time a customer calls, then immediately transfer the information to the customer service representative. This option enhances customer service, in that the caller does not have to repeat information already given, and the customer service representative can respond quickly to the caller's needs.

Customized browser-based desktop

The PGBA desktop offers essential tools for customer-focused service through a single user-friendly browser application. It collects a caller's identification information at the time of the call and immediately populates the data onto the customer service representative's computer monitor, or "desktop." This functionality helps representatives check benefits, eligibility, claim summaries and out-of-pocket expenses at a glance, and access other data pertinent to the call. Desktop applications can be further customized to incorporate features such as a searchable knowledge base with scripts to guide problem resolution, as well as links to CMS reference material.

Telephone controls

Telephone controls centralize and monitor all agent activities during the call process while supporting more personal and courteous customer service. PGBA's telephone controls can also be integrated with the desktop option. For example, the "warm transfer" feature allows the transfer of caller identification and information at any point during the call and can include a transfer of the desktop screen to the receiving agent. Clients can also choose to offer Subject Matter Expert call conferencing as part of the integrated desktop feature.


The e-talk system features synchronized recording and playback that can monitor every aspect of a representative's conversation with a customer, including a capture of all computer screens used during the call. This data is then stored for easy evaluation and monitoring. The system allows for a search of previous recordings by group, employee or date.

Automated document generating system (ADGS)

This function is a web-based tool that generates customized letters to plan members. Clients can easily create and maintain their own letters. When integrated with the PGBA desktop and claims/enrollment processing systems, ADGS can systematically populate customized data within designated fields.

ADGS ensures the uniform and consistent presentation of letters, including client-specific letterhead and footers. Letters may be printed locally or at established remote printer sites, using digitized logos specific to each printer. Copies of all letters are stored on the PGBA coded data system for easy retrieval.