Member Policy Administration

Enable customers to manage account changes, payments, and claims after enrollment.

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Overview

Dependency on legacy infrastructure and the use of multiple systems-of-record inevitably creates “member fatigue” and leaves health plans susceptible to low CAHPS ratings and Net Promoter Scores. And managing complex network relationships to increase provider satisfaction and lifetime value is too difficult for most insurers to tackle.

  • Vlocity’s Contact Center Module drives targeted engagements that are both efficient and tailored to the member or provider encounter. Our Contact Center Module provides the interaction framework that guides internal users, intermediaries, or the customers through optimized service interactions. It starts with a 360-degree view that provides comprehensive information about a member’s benefits, plan information, and claims
  • Then the Vlocity Interaction Launcher finds and verifies the member or provider on the call.
  • Our Customer Story tools let an agent quickly identify all of the interactions they've had with a customer in a single place without having to search so they are more efficient
  • Vlocity Platform Capabilities (like OmniScript™, Cards, and DataRaptor™) make agents smarter by walking them through a rules-driven decision tree
  • We also track the click-stream data from each interaction and then aggregate it inside Salesforce Analytics Cloud and our Business Intelligence Module
  • And, Vlocity can turn a problem into an upsell opportunity using the deep customer insights available in our Intelligent Member Profiling. Vlocity gives health plans the tools they need to truly listen, resolve, and satisfy member inquiries

Key Features

  • Member & Related Parties Search & Verification
  • Smart Agents Configurable Decision Scripts
  • Member Benefit Search Inquiries
  • Member Claims Search Inquiries
  • Member Pre-Authorization Inquiries
  • Member 360 View, Relationship Graph, & Customer Story Timeline
  • Configurable Quick Actions to from Back Office Sources
  • Intelligent Member Profiling with Automated and Manual Tagging
  • Interaction Summary with Customer Intent Tracking

Vlocity Delivers Latest Release

Integrated with Salesforce Health Cloud

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