Adapt to Rising Member and Provider Service Expectations

Deliver service excellence through seamless access to benefits content.

Minimize Errors/Inconsistencies in Benefit Quotes

Auto-Generate Benefit Quotes

Customer Service Representatives (CSRs) get a unified view of benefits content, aggregated and transformed across various data sources including structured/ unstructured data and documents. Auto-generate Benefit Quotes with a click of a button. The NLP Dictionary preloaded with 40,000+ medical terms helps improve the accuracy.

Minimize Errors/Inconsistencies in Benefit Quotes

Auto-Generate Benefit Quotes

Customer Service Representatives (CSRs) get a unified view of benefits content, aggregated and transformed across various data sources including structured/ unstructured data and documents. Auto-generate Benefit Quotes with a click of a button. The NLP Dictionary preloaded with 40,000+ medical terms helps improve the accuracy.

Empower CSRs

Automate Intelligent Recommendations

Advanced IntelliSearch™ capabilities allow benefits search using English text or codes. Recommendation Engine enables CSRs to make recommendations. Expert users are empowered to train the system and implement learning models to generate increasingly better results to answer benefit inquiries.

Improve Contact Center KPIs

Boost Star Ratings

End-to-end automation and Advanced Analytics of benefits inquiries significantly improve KPIs. This results in reduced call handle and call hold time, higher first call resolution rate (FCR), reduced CSR attrition, and improved Member and Provider satisfaction.

Improve Contact Center KPIs

Boost Star Ratings

End-to-end automation and Advanced Analytics of benefits inquiries significantly improve KPIs. This results in reduced call handle and call hold time, higher first call resolution rate (FCR), reduced CSR attrition, and improved Member and Provider satisfaction.

Provide Consistent Omnichannel Self-Service

Empower Digital Front Door

“Digital Content Manager” enables content rules configuration and provides consistent omnichannel access to benefits explanation through Digital Front Door — including Portals, Chatbots, and Mobile Apps. Members and Providers can get answers to most of their questions with a few clicks and call customer service only for complex queries.

Listen to Our Customers

Frequently Asked Questions (FAQs)

Here are the answers to the most frequently asked questions about implementing end-to-end member and provider benefits inquiry management solution and partnering with Simplify Healthcare.

What is Member and Provider benefits inquiry management?

Most Health Plans, TPAs, and ASOs face challenges with manual and inaccurate explanation tools to improve self-service and handle benefit inquiries, version control issues, redundant and disconnected benefit content across the enterprise, and extended call handle times. Member and Provider benefit inquiry management is the process to support health plans by automating end-to-end customer service management and delivering accurate and complete information to your call center and self-service portals.

What are the challenges with traditional customer service management processes?

Traditional customer service management for Payers, TPAs, and ASOs are manual and prone to errors. Customer service users are frustrated over the amount of time and steps required to accurately quote benefits leading to many errors and overall reduced member and Provider satisfaction. The challenge:

 

  • Current benefit explanation tools are incapable of providing accurate member or provider self-service.
  • The process of searching through benefit data sources-marketing and other documents are time-consuming and error-prone.
  • Benefit explanations are not human-friendly with multiple versions and inconsistency across the enterprise.
  • Several manual steps, several data sources, and following of complex job aids increase errors and result in MTM and NPS impacts.
  • With inconsistent data, customer service team may need to spend extended time researching and respond to benefit inquiries and reduced the first call resolution rate and extending call handle time.

Why use a member and provider benefits inquiry management solution?

Here are some of the key benefits of automating your member and provider benefits inquiry management processes:

 

  • Create a single source of truth for your benefit explanation data to provide fast and accurate benefits answers consistently across all your channels
  • Automate workflows for easy collaboration across all stakeholders, reduce administrative costs, and increase member retention and service search capabilities using English text or codes
  • Reduce errors, call handle time, and inconsistency across channels
  • Increase first call resolution rates
  • Reduce the amount of time and steps required to accurately address benefit inquiries
  • Automate Member and Provider self-service and increase satisfaction
  • Improve Star ratings

How can eServiceSync™ help you automate processes?

eServiceSync™ enables Healthcare Payers, TPAs, and ASOs to provide better member and provider self-service by enhancing their customer service capabilities with an end-to-end automated platform that integrates into your existing CRM investments. The proven platform helps deliver accurate and complete information to your call center and self-service portals, improve call handle times and first call resolution rates, provide current, accurate, and complete benefit explanations, and improve your Member and Provider experience, and increase your Star ratings.

Payers and TPAs can now automate workflows for easy collaboration across all stakeholders, reduce administrative costs, and increase Member retention and service search capabilities using English text or codes.

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