Customer Success Stories

Enhancing Operational Efficiency through Seamless Salesforce Service Cloud Integration

  • United States
  • Healthcare
  • Implementation & Integration
  • Salesforce Service Cloud
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96.67

Reduced GOP creation time

91.67

End-to-end case handling time

About Company

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.

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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

Solutions

  • 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

Related Insights

Transform and optimize the heartbeat of your operations, systems and product development to reduce costs and facilitate growth.

Decision intelligence matched with customer success

We put people first—our team, our clients, and our community. With the right technology, talent, and strategy, we deliver real results that drive success.

1500

Successful Customers Engagements

4.9

Customer
Satisfaction

350

Decision Science
Consultants

21

Years Of
Customer Success

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