Supercharge Your Automation to Better Address MA Member Needs


Medicare Advantage plans recognize that the primary touchpoints with customers are through enrollment and billing. Often treated as discrete operations, the reality is that they are interconnected and also hold many contact points in between. Payers who want to streamline operations while boosting customer satisfaction look for a platform that links enrollment and billing while connecting all of the dots for members.

This is particularly important as the Medicare Advantage market is expanding and becoming more competitive. Overall plan quality has improved, according to a McKinsey analysis, but patient experience and access scores have not improved as quickly as other metrics, creating an opportunity for differentiation.

Customer Experience Best Practices

According to the Forbes Technology Council, best practices for improving the customer experience include keeping it simple, eliminating redundancies, and ensuring customers must give information only once.

How can MA plans meet these standards? By providing customers and customer service representatives (CSRs) with better tools. Automating and integrating each member touchpoint allows simple self-service for members and allows CSRs to quickly navigate through all of the modules they may need to provide the best assistance.

Reducing Frustration

Phoning in to health plans can be a frustrating experience for members. A customer connection platform with advanced interactive virtual response ensures that members don’t get lost in a maze and don’t have to repeat information multiple times over the phone, or when switching from online to phone interactions.

Customer-facing dashboards can empower customers to bypass the agent if they choose and handle basic tasks on their own. And when members want or need personal assistance, click-to-chat and advanced interactive voice-response capabilities should connect them with an agent who has all the right information at their fingertips.

Better, more-connected technologies reduce frustration for CSRs as well. One of the most difficult tasks for a CSR is searching through multiple data screens while trying to provide high-level service to a customer on the phone.

New automation technologies can guide agents through enrollment, claims, care management and billing platforms, pulling up relevant information based on prompts in the conversation. This greatly reduces the amount of time needed to evaluate member history and “provide a 360 view of everything associated with the member,” says Ameerah Murray-Whitaker, VP of technology enabled solutions for Convey Health Solutions.

For example, searching for claims data would typically take a CSR several clicks, navigating through both an enrollment app and a claims app. With technologies like Convey’s Miramar:Connect, the information is readily available to the CSR, so they can access both demographic data and targeted claims data without having to navigate to locate it, Murray-Whitaker says.

CSRs also benefit from automated pre-population of data provided by members that start their interaction through click-to-chat but then switch to phone. This way, the CSR does not have to repeat questions that may be off-putting and can establish rapport earlier in the call, says Scott Tracey, SVP of IT operations & security for Convey.

Miramar:Connect–What’s on the Horizon?

In addition to the current features offered by Miramar:Connect, the technology is being expanded to include robotic process automation for payers. This will include:

  • an assisted bot solution that guides CSRs through screens, with pre-set responses and compliance activities triggered when specific apps are opened or information is entered in certain fields. This will reduce both time and manual work for agents.
  • a solution that enables handing of sensitive data where the CSR lacks the authorization to complete the transaction for the member. In such cases, the bot can fulfill that role so the CSR can complete the transaction without needing to transfer the call.

Today’s MA members are looking for a seamless, simple and connected experience with their plan. They expect easy-to-use self-serve features, customized alerts, and CSRs who can provide fast access to questions on enrollment, billing, health information and plan features.

Meanwhile, agents need an easily navigated dashboard that connects billing, enrollment, eligibility, benefit and personal information about the customer while aggregating data and automatically reconciling alerts and action items to the member’s file.

Payers can provide this with Miramar:Connect, which closes the loop on both consumer-facing and CSR-facing technologies to provide members with an easy and well-informed experience each time they interact with the plan.

Convey Health Solutions focuses on building specific technologies and services that can uniquely meet the needs of government-sponsored health plans. Convey provides member management solutions for the rapidly changing health care world. To learn more about how our Medicare member management solution can benefit your health plan by enhancing the member experience, please navigate to our Miramar:Connect webpage for more information.
First seen on SmartBrief.