Healthcare Payers

Mobile self-service, omni-channel engagement, and workforce optimization solutions help payers improve member retention and satisfaction, and deliver patient-centric outcomes while reducing operational costs. This thoughtful balancing of quality and efficiency is the cornerstone for payer success in today’s healthcare setting.

Improve Patient Engagement

Patients want to engage with payers through their mobile devices, via SMS, web chat, chat bots, and email. Payers must empower members to handle a variety of tasks within – and across - these preferred channels. Such tasks could range from shopping for health plans, inquiring about billing and claims, understanding benefit and policy changes, and generally managing their accounts. Payers can also leverage self-service and omni-channel solutions to proactively deliver timely, personalized information. For example, payers can provide benefit reminders and information over SMS and staff members can optimize their outreach for new member welcome calls and follow-up to both members and providers.

Connect Clinicians to Payers Through Omni-Channel Technology

Payers’ medical directors are required to connect with patients’ providers on a consistent, ongoing basis in order to assess medication protocols, treatment authorizations and guidelines for (sub) specialties consults. Having an omni-channel solution with a robust, comprehensive IVR system reduces the number of misdirected calls and directs physicians to clinical activity coordinators who can better facilitate transactions between facilities and the physicians who represent the payer. Additionally, phone trees and skills-based routing ensures urgent calls are directly routed to the care team.

Optimize Payer Contact Center Efficiency with Workforce Optimization and Back Office Solutions

The dramatic shift in care models and increase in demand has plagued payers with understaffing during high call volume periods and peak enrollment cycles leaving members and providers on-hold for extended periods and causing high abandonment rates.

Workforce Management solutions help payers track call volumes and project future trends to account for peak call times and thus avoid low staffing issues. Trends can also be used to develop profiles of the types and timing of issues spurring calls so that payers can implement and schedule strategies to improve future interactions. Additionally, call recording solutions help administrators identify gaps in processes and interactions.

In the back office payers struggle with the lack of workflow and process visibility. This has led to wasted calls between payers and providers, the over-processing of requests and delayed care delivery. Back Office solutions provide managers with full visibility of workflows while quality management tools ensure standardized processes are followed. KPIs guarantee accountability across departments and staff to nurture a culture of continual quality improvement.


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