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3 Key CRM Capabilities for Payers

By 11.23.20
Reading time: 3 minutes

Payers fight a never-ending battle to effectively manage relationships with the provider, group, and member communities — in addition to traditional operational challenges like claims processing times and aging technology. But now, they must also face new demands such as the never-ending stream of government regulations and demands to lower costs in the healthcare delivery chain.

How to keep up? Silverline’s payer consulting team uses Salesforce technologies to enable key CRM capabilities for payers — or what we call the 3 A’s — to be successful:

  • Attracting new groups and individuals
  • Acquiring them and completing the enrollment process
  • Administration and maintenance of member plans

Attracting new groups and individuals

Payers have a mix of entities they’re trying to attract and support, from individuals signing up through the Affordable Care Act to businesses looking for specific insurance coverage options for their team as a group. To continue to grow their operations, they must continually attract new individuals and new groups to their plans, like:

  • Creating specialized campaigns that communicate the payer’s message to the right audience (individuals, group administrators, brokers) via the most appropriate communication channel for that audience.
  • Setting up custom nurture flows that provide multiple touchpoints, giving prospects all the information they need to choose your payer
  • Build self-service portals for brokers that provide them with all the information they need to sell your products

Silverline uses Salesforce tools to craft solutions that offer different features that give payers the flexibility to reach out into a community to attract them to your plan, whether they’re using an in-house sales team or independent insurance brokers. Silverline helps payers guide members, group administrators, or business development teams with a more seamless customer experience.

Acquire and enroll customers

Payers have to juggle different products when acquiring new customers. This is where an avalanche of information comes in — gathering up everything you need to facilitate the enrollment process — and depending on the product, enrollment can look completely different. If you’re part of a group, for example, enrollment can be as simple as sending a census. For individuals, there might be some assessments done to determine eligibility.

With Silverline’s guidance, payers can help new customers select the products that best suit their needs. This capability makes the enrollment process much easier for brokers, business developers, underwriters, and membership team members. Keep these customers year after year with support for a renewal process that quickly re-enrolls members into existing or new products offered by the payer.

Administer and maintain member plans

Maintenance covers many different elements of the plan lifecycle, and can be the most complex of all to coordinate. Silverline leverages Salesforce tools to provide our clients with one picture of all individual or group activities so you can administer the full lifecycle of a plan, from contractual features to reacting to group and life changes experienced by the member population.

This includes:

  • Billing: Seamlessly handling financial tasks
  • Claims processing: Easily integrate with existing claims systems. Silverline’s solutions store data all in one place, so if claims or eligibility disputes arise, Grievances and Appeals teams have everything they need to adjudicate their cases. 
  • Member services: Field common questions from members, from sending new cards to tracking claims status and coverage options
  • Care management: Managing chronic illness or disease through lifestyle changes, like coordinating a smoking cessation program and medication compliance program for heart patients
  • Reporting: Making sure it all fits together

Master the 3 A’s of CRM capabilities for payers

Salesforce can help payers manage their operations at each stage of the funnel: Attract, Acquire, and Administer. Stop missing opportunities to view agent productivity, issue trends, and problem providers with Salesforce.

That’s exactly where Blue Cross Blue Shield of Wyoming (BCBSWY)’s provider relations team was last year. They were manually tracking all of their communications and missing touchpoints with prospects, customers, and physicians to attract, acquire, and administer their plans. Now, BCBSWY is empowered with the ability to view interactions in over 2,000 accounts in the first half of the month through tasks and activities.

With help from Silverline, BCBSWY doubled retention of members who are aging out of their current products at age 26 (dropping off guardian plan) and 65 (becoming eligible for Medicaid) by using Salesforce to identify upcoming birthdays to keep those members blue.

At Silverline, we create long-term relationships with our clients by working with them on their strategic objectives, providing thought leadership, and ensuring the highest quality of services that suit their unique needs. Are you ready to improve your CRM strategy and then some? Reach out.

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