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Simplify Member and Provider Benefit Inquiry Management

A single source of truth 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 to deliver accurate and complete information to your call center and self-service portals.

  • Reduce errors, call handle time, and inconsistency across channels.
  • Reduce the amount of time and steps required to accurately quote benefit inquiries.
  • Automate workflows for easy collaboration across all stakeholders.
  • Reduce administrative costs and improve your Star ratings.
  • Increase member retention and service search capabilities using English text or codes.

An end-to-end health plan administration and customer service management solution. Industry’s first single source of truth to manage members and providers self-service and benefit inquiries.

Business friendly, easy-to-use and implement.

eServiceSync™ is a scalable, high-quality suite to automate customer service/user inquiries and provide accurate and on-time information in a simplified way. The intuitive solution smoothly integrates into your existing CRM investments, Core-Admin, and other systems to better share data and eliminate errors, efforts/costs.

Data aggregation and transformation across variety of data sources.

The robust solution allows health plans to consolidate information at once place, automate benefit explanations, and aggregate data sources including code library, benefits SOT, medical policy, COB, PreAuth, Provider (for Network Tier), Eligibility (to determine Product ID), Accums (to look up accumulators), cost estimator, claims history.

Automate search for a service or benefit inquiry information.

Search for a service using English text or codes. The solution uses AI and NLP technology to look for match for the service by traversing the code library and its English descriptions, correlating it to the benefit categories and services.

Why eServiceSync™?

eServiceSync™ uses advanced technologies AI and NLP to enhance customer service management, improves end-to-end customer, member, and provider experience, and automates service delivery with key search capabilities.

Learn how eServiceSync™ can help health plans enhance customer, member, and provider experience using advanced technologies.

Frequently Asked Questions (FAQ's)

Here are the most common, frequently asked questions about implementing end-to-end benefit inquiry management solution and partnering with Simplify Healthcare.

1. What is member and Provider benefit inquiry management?

Most health plans 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 deliver accurate and complete information to your call center and self-service portals.

2. What are the challenges with traditional customer service management processes?

Traditional customer service management for health plans 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 to
    research and respond to benefit inquiries and reduced first call resolution rate and extended call handle time.

3. What are the benefits of automating your customer service management processes?

Here are some of the key benefits of automating your customer service 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 members and providers self-service and increase satisfaction.
  • Improve Star ratings.

4. How can eServiceSync™ help you automate processes using a single source of truth?

eServiceSync™ enables health plans 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 create a single source of truth to 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.

Health plans 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.

Ready to get started with eServiceSync™?

Are you interested in learning more about eServiceSync™? Our team is ready to answer all your questions. Let’s make smarter health ecosystems together! Schedule a 1:1 demo with us.
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