Revolutionizing Provider Services and Support through SmartBPM®

For payers, it's important to keep providers satisfied with the efficiency and quality of the services provided for them. Paying claims on time is only one part of that: Payer organizations must deliver personalized, accurate, and responsive service to providers as well.

Pegasystems' Provider Services Solution Framework™ anticipates the needs of both the customer service representatives (CSRs) and of the providers they serve. It's important that CSRs have the tools they need to drive the work through to completion. This rules-based framework delivers the agility required in today's dynamic environment to quickly re-engineer provider-facing business processes. It allows payer organizations to respond quickly to changes in organizational objectives, market opportunities, or health-industry regulations in order to deliver CSR productivity, provider satisfaction, and more efficient compliance with employer service-level agreements.

Benefits

• 65% reduction in manual decisions
• 35% increase in issues resolved per contact
• 20% reduction in call wrap-up work time
• 50% reduction in CSR training time
• 26% reduction in call handling time

Used in conjunction with our Member Services Solution Framework™, Provider Services allows payer organizations to create a fully-integrated customer service center that will deliver even greater growth, productivity, and compliance in a continually changing environment.

Key Features

• Interaction and activity management — Delivering comprehensive, relevant member information to a single screen view, Provider Services eliminates time-consuming toggling between systems.
• Channel management — The application delivers service consistently and seamlessly across Web, e-mail, Computer Telephony Integration (CTI), Voice Response Unit (VRU), Interactive Voice Response (IVR), and more.
• Service management — Rather than routing or escalating work for manual intervention, Provider Services uses pre-configured workflows to streamline contract-maintenance transactions, benefit inquiries, and claim-status inquiries, eliminating processing errors and decreasing member callbacks.
• Offer management — Provider Services enables CSRs to proactively offer new programs that promote member retention, Web self-service, and wellness programs — promoting healthier, happier members and lowering medical costs.
• Performance and compliance management — The solution extends managerial oversight across your customer-service activities with comprehensive performance management, reporting, and self-documenting capabilities.
• Change management — Built on PegaRULES Process Commander®, this solution empowers business users to personalize processes efficiently to respond to changing business conditions.