A leading health benefits provider, focused on building a modern, high-performing health system, selected Salesforce Service Cloud to streamline operations, enhance customer support, and unify their technology-driven care solutions. To ensure a seamless integration, they brought in CRMIT Solutions, whose expertise in Salesforce implementations enabled the creation of a customized, efficient platform that significantly improved interdepartmental collaboration, and automated key processes, and delivered measurable improvements in operational efficiency and customer satisfaction.
Business Challenges
Siloed Communication: Eight different teams operated in isolation, relying solely on emails for communication. This approach led to significant inefficiencies, with agents spending excessive time manually extracting and inputting customer information from various systems
Interdepartmental Collaboration: Collaboration across departments was restricted to email exchanges, which hindered effective monitoring and status updates
Scattered Data: Critical data was dispersed across multiple internal systems, leading to inefficiencies and obstructing effective decision-making
Lack of Automation: The existing system lacked automation for case creation, routing, and comprehensive reporting capabilities, which further slowed down operations
Inefficient Case Routing: There was a pressing need for an efficient system to route cases based on agent skills and clear categorization to enhance clarity and reduce misrouted cases
Inadequate Request Management: Departments needed a system to manage requests and track child cases for better oversight
Limited Supervisor Tools: Supervisors required dashboards, automated workflows, and comprehensive reports to manage operations effectively
Manual Data Collation: Agents had to refer to 14 different platforms to manually collate member-related data, consuming excessive time
Solution Details
Customized Platform Creation: Developed a platform from scratch that seamlessly integrated all teams and improved productivity and estimated times of arrival (ETAs)
Transparency: Set up transparency features that allowed each team to view cases and monitor their status
Customized SLAs: Created new SLAs for each team, clearly defining ETAs for seamless processing of member requests
Case-specific Chat Functionality: Enabled chat functionality specific to each case, ensuring all communications were centralized and case-related
Case Reassignment and Transfer: Enabled supervisors, managers, and agents to reassign or transfer cases within and between departments
Child Case Management: Created child cases for requests that could evolve into payment requests, ensuring comprehensive management
Automated Case Generation: Automated case generation and approval processes through integration with internal systems
Detailed Case Capture: Implemented deduplication rules for case creation to ensure all necessary details were captured for existing cases
Salesforce Service Cloud Integration: Integrated claims management in Salesforce Service Cloud for comprehensive medical record reviews, proactive communication, and efficient case routing
Automated Priority Assignment: Automated the assignment of case priorities based on type (Member, Provider, Payments) for more streamlined handling
Omnichannel Case Routing: Utilized Service Cloud’s Omnichannel assignment rules to route cases efficiently to appropriate users, groups, or queues
Single Source of Truth: Consolidated policy information within Salesforce, providing a unified source for claims processing
Enhanced Workflow: Integrated member and provider search, detail capture, document management, and benefit selection for more streamlined payment processing
Custom Flows and Notifications: Configured custom flows, email templates, notifications, and knowledge management tools to support case resolution
Tailored Entitlement Processes: Established new SLAs aligned with business requirements to manage service-level agreements (SLAs) effectively
Comprehensive System Integration: Integrated all 14 internal systems, allowing for the collation of all relevant data with a single click
Value Delivered
Improved Communication and Coordination: Implementation and integration of Service Cloud enhanced interdepartmental communication and coordination, increasing agent efficiency
Enhanced Information Retrieval: Improved retrieval of member and provider information, facilitating better case management
Decreased Case Resolution Time: Efficient case routing and prioritization significantly reduced case resolution time, reducing the backlog
Reduced Misrouted Cases: Automated routing of cases based on agent skills and clear categorization reduced the number of misrouted cases
Streamlined Approval Processes: Simplified and streamlined approval processes within Salesforce, improving operational workflows
Efficiency Tracking: Introduced reporting to monitor the efficiency of end-to-end case handling
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3, true, IN, https://www.crmit.com/wp-content/uploads/2022/08/mickey-bedi.jpg, Mickey Bedi, Vice President & Geo Leader of India, mickey.bedi@crmit.com
CRMIT Solutions
