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Health Cloud Implementation Helps Large Healthcare Payer Enhance Member Experiences and Improve Operational Efficiencies

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This client is a large payer in the Southwest, with well over 1 million members and nearly 2,000 employees. Their primary focus is helping people get healthy and stay healthy.

The need: a better view into member engagement

The client knew they were behind the times in terms of technology and member expectations surrounding customer service. They needed to create a seamless experience that supported the full lifecycle of member engagement. They wanted to provide members with self-service interactions as well as enhance member interactions with their knowledgeable contact center agents. 

Agents in the call center desperately needed a unified view of member profiles to better assist in customer service scenarios. The executive team wanted a solution that would focus on member satisfaction, to help drive member growth and reduce costs overall. 

The client knew that enriching member interactions to create a unique experience for each member would drive satisfaction and surface new revenue opportunities. But they didn’t know how to re-architect their approach, especially as it pertained to integrations with other backend systems.

The client engaged Silverline to help them create a better member and employee experience at every touchpoint throughout the member journey in sales, broker support, service, and marketing. 

The strategy: seamless integrations for improved interactions

To get started, Silverline met with the client to perform prerequisite process mapping, workflow mapping, and blueprinting. During these sessions, Silverline visually overlayed different processes on top of each other to see where they could be made more efficient. This also helped to ensure a clearer delineation of work across the organization when creating new processes and automations. 

Silverline successfully implemented Health Cloud, Marketing Cloud, and Salesforce Shield to create a comprehensive solution that provides a unique experience for each member.

Working closely with their team, Silverline used the Salesforce Industries’ suite of products to provide a 360 degree view of every customer service interaction with their members.

Silverline also created automated member journeys with proactive interventions that used omni-channel capabilities based on member-specific preferences and activity that enriched each member touch point. The user interface displayed dynamic content based on the type of caller and the context of the conversation.

Finally, to provide the client’s team and members with the most current information, Silverline developed integrations with other systems. 

For example, their Salesforce Org now communicates easily with their phone system, Avaya. When a member calls in with a query and enters their member ID, Avaya identifies that member and serves up the appropriate member data to the agent who takes the call. These integrations ensure that the system provides the most critical information in real-time to the member services’ agents.

The results: enhanced experiences and operational efficiencies

The new Salesforce-based solution has greatly enhanced the client’s relationship with their member population. Integrations between their claims system and provider database allow agents to provide a member-centric approach to delivering care. The new system has also drastically reduced the amount of dead air time on calls while the agent clicks around, searching for the correct answer or next step.

Silverline and the client continue their partnership as new capabilities will be added for sales, marketing, service, and other areas within their organization. Also, new member and provider capabilities, such as self-service functionality will be added to this impressive solution.  

This new system also provides the client with the ability to add new features — care management being one of them. They have the infrastructure in place that will support adding additional functionality for their agent care guides to have at their fingertips.

Interested in how you can do the same for your company? Talk to one of our experts today.

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