Optimize First Impressions with Consumer-Focused Sales and Enrollment

The challenge: With healthcare reform driving the business, health plans must work harder to gain and retain members. Stricter governmental control including state-run insurance exchanges, uniform plan designs and tighter rating regulations make it harder for plans to differentiate themselves in critical new business activities.

With Pega’s solutions for sales process management, health plans can rapidly design and implement dynamic sales and on-boarding strategies at substantially lower cost. By combining intelligent process automation with real-time decisioning across all channels, these solutions for both individual and group sales facilitate best-practice quoting, rating and underwriting while streamlining application submission and enrollment.

Pega makes it easy for health plans to become adept at creating distinguished sales and enrollment experiences that are simultaneously tailored to the applicant, compliant with governing mandates and easily executable across isolated systems. From the point-of-sale to back-office approvals and fulfillment, the world’s largest health plans trust Pega to help them substantially increase offer uptake, drive on-boarding costs to their lowest level and reach new markets in significantly shorter time.

• Increase conversion rates. Intent-driven processes and advanced analytics dynamically merge business goals with user intent to deliver personalized, real-time offers that yield the best outcome for your customer and your organization.
• Maximize sales across channels. Pega unifies policies with procedures so that you can centralize your sales strategy across all channels, increasing efficiency and reinforcing the brand with each interaction.
• Cut on-boarding time and costs. Seamless integration between sales and application processes combined with automated guidance, materials fulfillment and status updates streamline on-boarding for self-service customers, agents and direct-sale representatives.
• Optimize health insurance exchanges. Process controls automatically identify and correct reconciliation issues, enabling intelligently exchanged sales and enrollment transactions in preferred HIX formats.

Learn more:  Healthcare Group Sales Process Manager and Healthcare Individual Sales Process Manager data sheets

Customer Success
	Turning a Bold Vision into Business Agility A regional Blue Cross and Blue Shield plan realized 40% growth in targeted membership by improving the on-boarding experience and speeding the enrollment process by 80%. New feature and new program development cycle time has been reduced by 75%, enabling even greater membership growth as the Plan can quickly respond to the accelerated rate of regulatory and market change.
	Capturing a New Market in Record Time Deployed in under 90 days, this Pega solution enabled CSC to deliver a prescription drug plan that has grown its client’s Medicare Part-D business from $0 to $1 billion in less than a year. The organization has increased enrollment to over a million members while significantly reducing staffing levels, average call times and training costs.
	Dramatically Increasing Market Share with Automated Underwriting With a focus on being easy to do business with, a large health plan organization turned to Pega to automate underwriting. As a result, the plan tripled the instant issue rate for online individual applications, achieved a 4% increase in the sales close rate and accelerated time to market with three major releases in under 13 months.