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Operating Efficient Payer Call Centers with Salesforce

By Paul Peterson 11.30.20 Payer Call Center employee answering questions while working from home

With the challenges payers have faced this year, your call center is likely busier than ever.

At many call  centers, the ability to effectively serve customers is negatively impacted by the agent’s need to access multiple legacy applications — frequently with a need to re-key and search for information separately in each — made all the more difficult by current needs to work from home in a decidedly non-traditional contact center capacity.

Sound familiar? We hear it all the time from our clients.

Current technologies provide fragmented solutions to payers. Some of these solutions excel at processing claims but create a poor experience for servicing members. Others patch together systems that struggle to create a seamless experience for the payer user community. Systems don’t always communicate, such as a sales solution that doesn’t integrate with a membership system. This results in a poor experience for all payer team members, group administrators, and members.

Members today expect a more connected, personalized experience where questions can be answered quickly and easily. Using Salesforce’s technology tools, Silverline can help you answer inquiries from members, groups, and providers quickly and efficiently.

Answer the most frequently asked questions easily 

You probably already know the top questions your customers are asking. So how long does it take to answer them? Your members usually want to know…

  • Can you send me a new card?
  • Is my provider in-network?
  • Do I need a referral?
  • What’s the status of my claim?
  • Am I eligible for this service? Do you cover XYZ?

Insurance policies are notoriously challenging for the average consumer to navigate. Even if you’ve provided comprehensive documentation, it’s unlikely the average person will read it. Doctors rarely mention insurance coverage, focusing on taking care of the patient. 

Most patients don’t realize how their plan works until they get the bill or Explanation of Benefits (EOB). With such an expensive healthcare system in the United States, your members want to know what’s covered and what’s not so they can make the best possible decision about their care. They expect that when they call in, you’ll have the answers to those questions quickly — so it may come as a surprise when a quick phone call or chat turns into an hour on the phone.

That’s not an ideal customer experience, but it’s also not an ideal employee experience. Empower your call center team by giving them the resources they need at their fingertips. Rather than waste precious time and resources, automate the process. 

How Salesforce can help your payer call center

Underpinning a great customer experience is technology that brings together multiple sources of data and resources, giving your payer call center team everything they need quickly and efficiently. This minimizes dead airtime, waits and holds, rote administrative tasks, and gets the patient focused on what matters: their health.

A 360-Degree View

Most payers have multiple systems that keep track of different aspects of their plans. Call center agents have to dig through multiple screens to find what they’re looking for. We’ve had clients with teams using eight different screens, with eight different logins and eight different user interfaces, just to answer basic, frequently asked questions — whew! 

All that translates to is dead space on the line, hold music for the patient, or a frustrated caller.

Wouldn’t it be great to have everything on one screen, so your employees don’t have to click around to find the answer? Silverline’s solutions let you see exactly what’s happening with members, from the very beginning of their relationship with the payer. Silverline provides payers with the tools necessary to assist the Member Services team with any inquiry by members, group administrators, or providers.

It’s a single pane of glass — one window, one screen — that has all the information member services need to answer questions quickly.

Care Management

Take an active role in member health. Whether it is helping a member maintain their disease management program or providing answers to member-submitted health questions, effective care management is crucial to the successful relationship between the payers and their member and group communities.

Take diabetes patients for example. A care management plan using Salesforce Health Cloud gives you visibility into their activities so you can close gaps in care, keeping their weight under control, monitoring incident levels, and making sure they’re accessing the services they need.

Our Salesforce implementations are designed to help you identify gaps in care, create health maintenance programs, and monitor the adherence to these programs. Using the same tools as those for marketing outreach, payers can create a journey for their members that improves their health, manage specific conditions, or support them on their health journey.

Intelligent Insights

Do you know the ROI on your payer call center right now? 

Salesforce gives you easy-to-understand dashboards so you can track call times, wait times, and opportunities. You’ll know what’s working, what needs improvement, and what information your other teams should know — say, a marketing-initiated follow up after a successful customer service call for renewal.

The foundation of any successful call center is information, but you have to make sense of all that data. Get access to real-time metrics, like new and existing market opportunities, addressing gaps in care when creating care management plans, or identifying key utilization trends.

Do more with Silverline

Salesforce is more than just a CRM. With Salesforce and Vlocity, you can automate business processes, integrate with external applications, and ensure compliance with insurance regulations. Take our client Amida Care as an example. As a nonprofit providing services to at-risk members spread across five separate NY communities, Amida Care needed a customer service ecosystem and backend environment that synced up their large amounts of data effortlessly.

With Silverline’s ongoing process improvements powered by managed services — Amida Care now uses multiple integrations that allow them to leverage data within other platforms to provide not only the best member experience, but also a productive  user experience for their staff — with access to data at their fingertips.

With the right tools for automation, your call center can do the same. Silverline can help you run your member services operations more smoothly and increase your team’s bandwidth to tackle more nuanced customer-centric concerns. Interested? Reach out.

Ready to see real results? We can help.

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