I'll go first. I did lots of policy writing, and SOP writing with a medical insurance company. I was often forced to do phone customer service as an "additional duties as needed" work task.
On this particular day, I was doing phone support for medicaid customers, during the covid pandemic. I talked to one gentleman that had an approval to get injections in his joints for pain. (Anti-inflamatory, steroid type injections.) His authorization was approved right when covid started, and all doctor's offices shut the fuck down for non emergent care. When he was able to reschedule his injections, the authorization had expired. His doctor sent in a new authorization request.
This should have been a cut and dry approval. During the pandemic 50% of the staff was laid off because we were acquired by a larger health insurance conglomerate, and the number of authorization and claim denials soared. I'm 100% convinced that most of those denials were being made because the staff that was there were overburdened to the point of just blanket denying shit to make their KPIs. The denial reason was, "Not medically necessary," which means, not enough clinical information was provided to prove it was necessary. I saw the original authorization, and the clinical information that went with it, and I saw the new authorization, which had the same charts and history attached.
I spent 4 hours on the phone with this man putting an appeal together. I put together EVERY piece of clinical information from both authorizations, along with EVERY claim we paid related to this particular condition, along with every pharmacy claim we approved for pain medication related to this man's condition, to demonstrate that there was enough evidence to prove medical necessity.
I gift wrapped this shit for the appeals team to make the review process as easy as possible. They kicked the appeal back to me, denying it after 15 minutes. There is no way it was reviewed in 15 minutes. I printed out the appeal + all the clinical information and mailed it to that customer with my personal contact information. Then I typed up my resignation letter, left my ID badge, and bounced.
24 hours later, I helped that customer submit an appeal to our state agency that does external appeals, along with a complaint to the attorney general. The state ended up overturning the denial, and the insurance company was forced to pay for his pain treatments.
It took me 9 months to find another 9-5 job, but it was worth it.
I also worked for an health insurance company, tho my experience was less extreme than yours it still sucked ass.
I worked the phones, and was hired together with a couple of other students through a student-oriented job agency. They lured us in with talks about how you can "really help people", and that pretty much every income call was "always positive", and naive young me believed it. I found out real quick that, surprise surprise, people don't call their insurance to tell them how happy they are with another out of pocket expense. And the helping people part was bullshit too. I couldn't waive fees, or approve insurance payouts, and when people wanted a payment plan I just filled in the form on the companies website for them. Wanted a payment plan that was different from the options on the site? Tough shit, either accept it or be prepared to be on hold for an hour while I transfer you to the department that might do it for you after grilling you for making, in their eyes, the bad financial decision of being alive.
I was lucky enough to never have been threatened on the phone, altho I couldn't say the same for my fellow student colleagues. When that was brought up with management they acted like it was the first time ever in the companies history, which I saw through immediately.
Since we were technically making financial decision for other people, we had to get certified. The process costed around 400 euro, but was refunded by the company on the condition that you worked there for at least a year. If you quit after 9 months you'd get 75% back, 6 months 50%.
I quit the day after being employed for 6 months, and have skipped past every call center job I have come across since.