Solutions: Health Insurance
Personalize the conversation and maximize the member experience

Member Acquisition

Member Acquisition

Improve conversion rates by increasing brand and health awareness

• Improve conversation rates. Leverage advanced analytics to identify relevant health campaigns, offers and recommendations which are aligned to existing and emerging members' needs and interests and increase conversion through relevant awareness and educational programs.
• Deliver acquisition campaigns via each member's preferred communication channel. Capture all responses and results to enhance decision making around program development.
• Improve lead quality and follow-up. Incorporate the member's profile, response and campaign information when distributing leads. Leverage intelligent, centralized strategies to allocate leads to the agent best able to pursue the conversation.
• Optimize marketing and acquisition strategies across channels. Deploy a centralized strategy for consistent, intelligent conversations across every inbound and outbound channel to ensure that offers and actions can be started and completed with efficiency and accuracy in the member, employer or agent's communication channel of choice.

Achieve growth with performance-improving sales practices

• Streamline on-boarding. Use Next-Best-Action guidance and real-time decisioning to dynamically guide agents, call center representatives and even online enrollees through the process of choosing plan options and completing complex applications.
• Automate and standardize processes. Improve underwriting rating and premium accuracy, drive service differentiation and increase operational efficiency with adaptive analytics and real-time decisioning.
• Sell the right products. Leverage user-friendly, functional tools to develop innovative product and service packages based on market segments.

Roll out new health and wellness programs faster

• Define health and wellness strategies that are the most likely to receive positive response from members. Visually monitor, simulate and optimize deployed strategies across segments and channels to understand their impact on behavior based on members' real time responses, health risk, cost-containment goals, growth forecasts and other healthcare metrics.
• Quickly define new value-generating programs and plans. Capture responses from agent and member conversations in real-time to spot trends and emerging market opportunities.

Retention

Retention, Cross-Selling, Up-Selling

Reduce attrition with a better customer experience

• Define the best healthcare and disease management programs and targeted incentives. Retain a selected member using advanced analytics to proactively determine member propensity to churn and real-time decisioning to incorporate health risk into the decision process.
• Proactively identify and reach out to members. Provide timely, customized and appropriate programs and health plans using analytics and decisioning in real-time, near real-time or batch.
• Optimize the member relationship. Use adaptive and predictive analytics to analyze member data for commonalities, determine member satisfaction across all key interactions and channels, and predict how they might be better serviced in the future.

More successfully identify cross-sell and up-sell opportunities

• Increase the likelihood of offer acceptance. Benefit from advanced analytics and real-time decisioning to proactively determine a member's propensity to accept enhanced health programs, such as health care and disease management incentives or add-on coverage.
• Optimize cross-selling and up-selling across channels. Implement a single, centralized cross-sell/up-sell strategy for inbound and outbound interactions across every communication channel.
• Respond immediately to change in market conditions. Plan decision strategies and determine the impact on groups and individuals, agents and the company with interactive, business-friendly tools that reduce the need for IT support. Deploy new strategies across all channels with the click of a button.

Retain at the right cost

• Optimize sales propositions. Use personalized business cases that simulate and optimize sales propositions in real time to determine customer retention strategies, budgets, offers and actions for each member and group.
• Dynamically lead selling conversations. Appropriately time offers based upon responses, mood and behavior with Next Best Action guidance.

Customer Service

Customer Service

Deliver a superior customer experience

• Make every representative your best representative. Guide them through each customer service conversation with the right information, prompts, scripts, answers and recommendations so that they can focus on the member's experience rather than convoluted processes.
• Personalize each conversation. Dynamically tailor recommendations and build customized programs based upon the individual's profile and history through adaptive analytics, real-time decisioning and Next-Best-Action.
• Enhance the quality of the member relationship. Analyze members' data for commonalities, determine whether members were satisfied across all key interactions and channels and predict how they might be better serviced in the future.

Drive incremental sales through service interactions

• Help representatives deliver relevant and timely offers during service interactions. Deliver dynamic recommendations based on the member's profile, behavior, responses and history. Proactively trigger personalized offers in real-time to eliminate dependence on staff expertise.
• More successfully drive care management initiatives. Easily aggregate and analyze customer data to distribute targeted profiles for members, products and channels that incorporate real-time personalization.

Reduce avoidable events

• Dynamically guide every conversation to the best outcome. Determine the right actions and recommendations based upon the member's responses, profile, interaction history and business objectives with real-time decisioning.
• Make every conversation consistent. Empower representatives with Next Best Action guidance and a unified, up-to-date view of each member that is instantly available across all communication channels.

Reduce time and costs for service interactions

• Reduce call and training time. Provide representatives with a unified desktop that eliminate silos of information and the need to tab through multiple screens or search for data in multiple systems.
• Optimize service operations. Manage the amount of time spent on each member, increase first-contact resolution and reduce average handle time with the ability to continuously monitor and control conversations and balance customer expectations with business objectives.
• Shorten interaction cycles. Consistently push personalized, quality intelligence to make sure that every member interaction across marketing, sales and service is treated as a connected conversation.
• Increase shared responsibility and call deflection. Deliver personalized self-service that leverages adaptive analytics, real-time decisioning and a universal member view to provide greater information access and self-management capabilities to members.

Claims Servicing

Claims Servicing

Reduce – and even stop – claims leakage

• Leverage adaptive analytics to combine a member's behavioral propensities with claims pattern analysis.
• Automatically trigger leakage detection activities during conversations using real-time decisioning.

Reduce – and even stop – claims leakage

• Achieve the best outcome for both the member and the company. Use claims predictions to determine the appropriate treatment, recommendations and actions. Dynamically guide the conversation with Next-Best-Action providing recommendations and actions based upon the member's responses and instant analysis of behavior.
• Help representatives quickly assess the situation with a unified view of the member and complete claims history available from a single desktop.
• Leverage real-time decisioning to identify the best settlement options based upon your company's claims objectives.

Compliance

Compliance

Adhere to privacy and regulatory compliance requirements

• Dynamically guide every conversation across every channel. Meet privacy and compliance requirements and increase consistency through real-time decisioning and Next Best Action guidance.
• Maintain a complete interaction audit trail. Automatically capture all conversations across every channel for a unified, up-to-date view of each member's profile and interactions.
• Appropriately restrict access. Provide a limited view of member data to agents, call center representatives and employers that is appropriate to their role.