Humana Inc. is driving an extreme makeover–in customer service,that is.

A few years ago, the national health benefits company identifiedservice as a competitive differentiator. Top leaders defined sixkey characteristics–accuracy, reliability, easy to use, courteous,proactive, and personalized–that contribute to a "perfect service"experience for consumers. According to Bruce J. Goodman, chiefservice and information officer at Humana, almost all IT projectsmust improve customer experience in one of these keyattributes.

"Anything we do has to match back to those characteristics," heexplains.

Headquartered in Louisville, Ky., Humana provides healthinsurance coverage and related services to approximately 11.3million members in 50 states and Puerto Rico. With Humana since1999, Goodman oversees more than 2,000 IT people in Louisville andGreen Bay, Wis., where a large sales back-office operation islocated. The company also uses offshore IT resources in India.

To provide more personalized customer service, Goodman and histeam recently implemented an alert system in Humana's call centerthat flags a caller's specific characteristics, giving customercare specialists an opportunity to discuss cost-saving options orbenefits and services that might be helpful to the caller.

"One of our challenges is how we can continue to use IT to gaininsight into what's really important to our members and then usethat insight to provide a better experience and help them withtheir wellness efforts," Goodman says. "The opportunities for IT toleverage this are limitless and rich."

To be more proactive, Humana recently began surveying membersimmediately after a service call as part of its ECHO, or EveryCustomer Has Opportunity, program. To date, Humana has surveyedabout 50,000 members a month to determine their satisfaction levelswith the carrier. Dissatisfied members receive a call from acustomer care specialist, who tries to determine the root cause ofthe problem and then fix it. "This is a very helpful feedback loopand is driving a lot of our initiatives," Goodman says.

Goodman and his team are working to expand the geographicalreach of Availity, Humana's primary gateway for the submission ofclaims and encounters. The portal allows physicians to log on toone common interface to access claims information. It debuted inFlorida in 2004 through a joint venture with Blue Cross/Blue Shieldof Florida (Jacksonville). With Availity, Humana currently isworking with Blue Cross/Blue Shield of Texas to add physiciangroups in Texas.

"Physicians don't want to have to log on to 20 different payorWeb sites and train their people how to navigate these sites,"Goodman says. "Availity takes the hassle out of that process andcan lower costs for participants."

Goodman and his IT team also are leveraging Humana's andAvaility's real-time capabilities to expand services to providers,including real-time claims adjudication and the Availity CareProfile. With patients' permission, Humana can use claims data toprovide physicians with a Care Profile that provides moreinformation about their patients, such as which prescriptions havebeen filled or what lab tests have been conducted.

Goodman's efforts to improve Humana's customer service throughinnovative IT projects have not gone unnoticed. He was named to CIOmagazine's CIO 100 in 2003 and Computerworld's Premier 100 in 2004.Goodman attributes such accolades to his strong IT team and hisability to align IT with the business.

Although he has been in insurance IT his entire career, Goodmaninitially intended to pursue engineering. He earned a bachelor'sand master's degree in electrical engineering from New YorkUniversity and was working on his PhD in solid-state physics whenhe began working in the IT department at MetLife to earn a living."It turned out working with computers in large insurance companieswas a lot of a fun and a big challenge, and before I knew it, I wasat MetLife for 23 years," he says.

"As IT becomes more pervasive throughout an organization, itmakes sense to combine these operations to balance the investmentsmade," he indicates. "This is the most exciting, rewarding careeropportunity I've had. Not only is it something that can helpshareholders, but if you do this right, you can help people."

Sharon Baker is a freelance business writer based in Charlotte,N.C.