Large Midwest Healthcare Payor

Improving Member Satisfaction With Omnichannel Communication and a Modern Data Platform 

What if... we could deliver a better member experience and increase customer satisfaction?

Our client is a leader in healthcare insurance, serving millions of individuals in the United States.

Man reviewing some data and analytics on his laptop.

Member Satisfaction Needed a Booster

External industry scoring by regulators, government agencies, and third-party firms reward organizations that provide high customer satisfaction. These scores influence a payor’s ability to obtain performance bonuses, become a member’s chosen payor, make certain claims about themselves, and obtain recommendations from analyst firms.

Our client’s internal and external customer satisfaction scores began to decrease due to unsatisfactory first-call resolution, inaccurate data, lack of omnichannel capabilities, and inaccurate billing information. The organization realized it needed an omnichannel member services program to increase the productivity of its Analytics Center of Excellence and provide a better informatics environment. This enterprise resource would allow the service team to more quickly and satisfactorily address member needs and support better experiences.

A couple at home reviewing their insurance on a tablet device.

Designing a Data-Driven Member Services Improvement Program 

The payer client wanted to better integrate all its member channels in order to provide a more cohesive and unified experience with improved communications and analytics.

We implemented a member services improvement program focused on:

  • Stronger omnichannel communications capabilities, including chat
  • Heightened data integration leveraging MuleSoft API, data ingestion, development, integration, design, and support services
  • Tableau reporting, visualizations, and business intelligence development for dashboarding
  • An improved user interface of the client’s internal member services portal
  • Project management, Scrum Master Agile leadership, project governance and oversight, data analysis, development, reporting, and testing

Migrating to a More Cost-Effective and Flexible Informatics Environment 

Our client needed to replace its aging, poorly managed, and expensive legacy informatics environment (IE) platform because it did not meet the company’s need for flexibility nor the specialized needs of its data scientists and advanced analysts.

Our team of ETL developers created a data movement code for the payer’s IE framework. Next, we fully migrated the legacy IE platform to Databricks in the Amazon Web Services cloud. The usage-based pricing of Databricks will reduce costs while extending the company’s advanced analytics and data modeling capabilities.

The non-monolithic, elastic solution offers a long-term self-service model in a more flexible environment and will allow employees to provide better service with quicker access to member data.

Equipped with a single view of the member profile, employees can drive more meaningful and productive interactions. 

Results

A female heathcare worker reviewing information with a patient.

Better Analytics Optimize the Member Experience

Our MuleSoft solution provided better navigation capabilities on the internal and external member portals by ensuring advocates, care managers, and clinical coordinators have access to the right information when engaging with a member. Equipped with a single view of the member profile, employees can drive more meaningful and productive interactions.

Tableau services ensure constituents have a common, governed view of customer data so that analysts can answer specific or unanticipated questions as the program evolves.

Our migration work enhanced the member experience and boosted the productivity of the Analytics Center of Excellence with a modern, cloud-based data lake architecture. The new platform has improved resiliency, elasticity, durability, agility, and provided the client significant savings and expanded functionality.

Enhanced data platform functionality and an accurate single view of member data increased first-call resolution and supports additional member communication channels, including chat.

The payer client trusted Perficient for this important work due to our history of successful partnership, our deep industry experience, our ability to quickly scale a multishore team, and our proven technical expertise in delivering Amazon Web Services, Databricks, and MuleSoft solutions.

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