Executive Summary
Mastek partnered with an Arizona-based non-profit healthcare organization to modernize its customer service experience for the Medicare Advantage (MA) population, resulting in nearly $240,000 in annualized savings. By migrating to the Salesforce CRM and integrating multiple legacy systems, Mastek significantly improved call center efficiency, customer satisfaction, and regulatory compliance.
Background
This non-profit organization provides nearly 2 million customers with health insurance and services, including Medicare Advantage plans designed for seniors and those with disabilities. The company employs over 3,000 staff members across three offices in the western region of the US, all dedicated to helping consumers get and stay healthy.
Challenge
When members and healthcare providers contact the organization’s call center, they expect fast, accurate responses to their questions and inquiries. But the company lacked the technology infrastructure to deliver a quality service experience.
Customer service representatives (CSRs) in the Medicare Advantage teams needed to swivel among five disparate, siloed applications to serve callers: HealthRules Payer (HRP) for claims data, OnBase for documentation, a NICE IVR system, Excel, and email. Because these systems weren’t integrated and lacked scalability, CSRs found it slow and cumbersome to handle common tasks like verifying caller identity for regulatory compliance, enrolling new members, and answering member or provider questions, especially as the member base grew. It was incredibly time-consuming just to create an issue within HRP, reducing staff productivity and hindering customer service.
As members grew more frustrated by high call handle times and delays, the client’s customer satisfaction ratings suffered—dropping as low as 2.5 out of 5 for one Medicare Advantage plan. It was clear the organization needed a more robust technology infrastructure to meet customer service expectations.
Not scalable – Clayco’s current systems (SAP SuccessFactors, JDE, ADP) were not scalable, and therefore, they were not able to accommodate business growth.
Outdated business processes – As the HR activities including onboarding, recruitment and delivery of employee experience had no technology support, the company couldn’t remain competitive in terms of talent acquisition and retention.
Unreliable reporting – As the systems generated multiple versions of truth, reliable reporting was not possible.
Not scalable – Clayco’s current systems (SAP SuccessFactors, JDE, ADP) were not scalable, and therefore, they were not able to accommodate business growth.
Outdated business processes – As the HR activities including onboarding, recruitment and delivery of employee experience had no technology support, the company couldn’t remain competitive in terms of talent acquisition and retention.
Unreliable reporting – As the systems generated multiple versions of truth, reliable reporting was not possible.
A UK government department has a back-end tidal protection system, built using accurate and reliable data from the UK’s largest network of tidal stations. They need to make this prediction capability available as an API to developers across the UK using a subscription (paid and free) model.
Solutions
- Salesforce Service Cloud
- Salesforce Health Cloud
- Mulesoft
- Reliable and insightful report generation
- Salesforce Service Cloud
- Salesforce Health Cloud
- Mulesoft
- OnBase Connector AppExchange
Results
The healthcare payer tapped Mastek for the project based on our deep experience and track record with other payers. Mastek kicked off the engagement in April 2023 with a technical discovery of the client’s systems from a Medicare Advantage (MA) line of business (LOB) perspective and then proposed that the MA Service teams could successfully move to the Salesforce CRM based on available infrastructure that was being used by other LOBs, creating a unified data view and improving process efficiency. Mastek completed this complex transformation in two phases totaling less than eight months.
Mastek resources also helped migrate the massive volume of data (including millions of claims), integrated multiple systems, conducted extensive testing, developed documentation, and led train-the-trainer sessions to support a smooth transition. Overall, close to 120 MA Service team members were migrated from HRP to Salesforce. The Mastek team worked closely with the client’s subject matter experts and internal project manager to complete the engagement on a seven-month timeline, going live with the first phase in September 2023 and the second phase in December 2023 while ensuring no impact to open enrollment.
Now Salesforce is the central platform for nearly 120 users including CSRs, leads, and managers across six Medicare Advantage teams, equipping them to provide a high-quality service experience. They can complete a call from start to finish within Salesforce, with a complete view of member demographics, group data, plan data, call history, provider data, claims history, and case status.
Driving Major Cost Savings
The client is realizing nearly $240,000 in annualized savings through the improved call center processes enabled by the Salesforce migration.
- Average call handle time dropped by more than 30% in just the first few months, saving 533 hours of CSR time per month and an estimated $120,000 per year.
- The additional time a CSR spends after the call to wrap up the details dropped by 50%.
- The enrollment team has saved 40 hours per month just by spending less time validating a new member’s demographic information.
- The process of completing prior authorization forms is significantly faster, resulting in estimated savings of over $31,000 annually.
- The Care Gap team is spending far less time massaging data manually, reducing data load time from 10 hours to 30 minutes.
Driving Major Cost Savings
The client is realizing nearly $240,000 in annualized savings through the improved call center processes enabled by the Salesforce migration.
- Average call handle time dropped by more than 30% in just the first few months, saving 533 hours of CSR time per month and an estimated $120,000 per year.
- The additional time a CSR spends after the call to wrap up the details dropped by 50%.
- The enrollment team has saved 40 hours per month just by spending less time validating a new member’s demographic information.
- The process of completing prior authorization forms is significantly faster, resulting in estimated savings of over $31,000 annually.
- The Care Gap team is spending far less time massaging data manually, reducing data load time from 10 hours to 30 minutes.
Streamlining the Work
Before, it took many tedious steps and an average of two to six minutes just to determine if the issue the member or healthcare provider was calling about already existed in HRP and whether it was open or resolved. Now, the call automatically triggers a Salesforce Case 360 Creation process and loads all the relevant data. Then it guides the CSR through a fast, easy process to create a new issue if needed and categorize the reason, using simple drop-down menus. This process has accelerated issue identification and resolution by about 50%.
The Care Gap team is finding it quicker and simpler to conduct outreach to determine the reason for the gaps in care and take measures to address and document those gaps in order to improve member care. They no longer use manual spreadsheets or spend hours handling data; instead, they access the necessary data and implement a solution right within Salesforce.
The Salesforce migration also streamlined HIPAA compliance, helping the client safeguard patient health information. CSRs previously conducted HIPAA verifications by asking the caller multiple questions and tracking the responses in Excel, which slowed the process and introduced compliance risks. A new verification launcher automatically identifies the caller from their queue and populates their member data on a shortcut screen, enabling the CSR to quickly verify identity and move on to addressing their issue.
CSRs have even gained better visibility into the member communication preferences, eliminating unwanted touchpoints and improving the service experience.
Delivering Robust Reports for Improved Insights
Reporting has improved significantly with the move to Salesforce, placing much more information at the Medicare Advantage teams’ fingertips.
Mastek provided managers with training on how to create reports customized to their own needs or to suit a leadership team request. They can easily report on metrics like percentage of HIPAA verifications completed, number of cases open vs resolved, issues that are overdue or will be soon, or average issue resolution time, for example. Managers can also create custom dashboards, choosing which reports they need to view at a glance. These reporting capabilities have reduced unproductive meeting time and improved visibility into the call center’s daily operations.
Creating a Better Path Forward
Encouraged by these results, the client plans to move other lines of business off disparate legacy systems and leverage the Salesforce functionality to improve customer service. With a robust CRM as the foundation, the company is positioned to enhance its experience on the member, provider, and broker portals, providing self-service options for tasks like requesting an ID card, changing an address, checking a claim’s status, and many more. Through a successful Salesforce migration, Mastek has paved a simpler path forward for other business lines.
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- Oracle Benefits Cloud Service
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- Oracle Goal Management Cloud Service
- Oracle Expense Cloud Service
- Integration with JDE Modules
After each bi-monthly board meeting, all applicant paperwork, supporting documents, and criminal history records would be stored in four to five banker boxes. Boxes were maintained for one year and then sent for destruction. The cost, labor, and storage involved in the maintenance and management of paper records were significant.
“Our six-year-old copier has over a million copies on it,” said Scheller. “We knew that there was an easier way to do this that would be more economical and beneficial for the applicant and the board.”
Moving to a cloud-based solution increased efficiency and lowered costs all around. “We’ve reduced our environmental footprint and simplified the process both internally and externally,” continued Scheller. “We built checklists into the system to ensure everything is in alignment and regulations are being followed.”
Streamlining the Work
Before, it took many tedious steps and an average of two to six minutes just to determine if the issue the member or healthcare provider was calling about already existed in HRP and whether it was open or resolved. Now, the call automatically triggers a Salesforce Case 360 Creation process and loads all the relevant data. Then it guides the CSR through a fast, easy process to create a new issue if needed and categorize the reason, using simple drop-down menus. This process has accelerated issue identification and resolution by about 50%.
The Care Gap team is finding it quicker and simpler to conduct outreach to determine the reason for the gaps in care and take measures to address and document those gaps in order to improve member care. They no longer use manual spreadsheets or spend hours handling data; instead, they access the necessary data and implement a solution right within Salesforce.
The Salesforce migration also streamlined HIPAA compliance, helping the client safeguard patient health information. CSRs previously conducted HIPAA verifications by asking the caller multiple questions and tracking the responses in Excel, which slowed the process and introduced compliance risks. A new verification launcher automatically identifies the caller from their queue and populates their member data on a shortcut screen, enabling the CSR to quickly verify identity and move on to addressing their issue.
CSRs have even gained better visibility into the member communication preferences, eliminating unwanted touchpoints and improving the service experience.
Delivering Robust Reports for Improved Insights
Reporting has improved significantly with the move to Salesforce, placing much more information at the Medicare Advantage teams’ fingertips.
Mastek provided managers with training on how to create reports customized to their own needs or to suit a leadership team request. They can easily report on metrics like percentage of HIPAA verifications completed, number of cases open vs resolved, issues that are overdue or will be soon, or average issue resolution time, for example. Managers can also create custom dashboards, choosing which reports they need to view at a glance. These reporting capabilities have reduced unproductive meeting time and improved visibility into the call center’s daily operations.
Creating a Better Path Forward
Encouraged by these results, the client plans to move other lines of business off disparate legacy systems and leverage the Salesforce functionality to improve customer service. With a robust CRM as the foundation, the company is positioned to enhance its experience on the member, provider, and broker portals, providing self-service options for tasks like requesting an ID card, changing an address, checking a claim’s status, and many more. Through a successful Salesforce migration, Mastek has paved a simpler path forward for other business lines.
- Oracle Human Capital Management Base Cloud Service
- Oracle Benefits Cloud Service
- Oracle Talent Acquisition Cloud Service (TEE)
- Oracle Time and Labour Cloud Service
- Oracle Goal Management Cloud Service
- Oracle Expense Cloud Service
- Integration with JDE Modules
After each bi-monthly board meeting, all applicant paperwork, supporting documents, and criminal history records would be stored in four to five banker boxes. Boxes were maintained for one year and then sent for destruction. The cost, labor, and storage involved in the maintenance and management of paper records were significant.
“Our six-year-old copier has over a million copies on it,” said Scheller. “We knew that there was an easier way to do this that would be more economical and beneficial for the applicant and the board.”
Moving to a cloud-based solution increased efficiency and lowered costs all around. “We’ve reduced our environmental footprint and simplified the process both internally and externally,” continued Scheller. “We built checklists into the system to ensure everything is in alignment and regulations are being followed.”
Data maintenance and access are critical, and Salesforce is such a powerful platform. I don’t have to guess about numbers or case status anymore as dynamic dashboards provide real-time access to reports and data.
– Executive Director , Matthew Scheller
Data maintenance and access are critical, and Salesforce is such a powerful platform. I don’t have to guess about numbers or case status anymore as dynamic dashboards provide real-time access to reports and data.
– Executive Director , Matthew Scheller
Challenges
- Disparate legacy systems created inefficiencies
- Lack of integration required swiveling between applications
- Cumbersome processes hindered the service experience
- Long average time to provide clarifications to members
- Disparate legacy systems created inefficiencies
- Lack of integration required swiveling between applications
- Cumbersome processes hindered the service experience
- Long average time to provide clarifications to members
Value Created
- Multiple systems migrated and integrated on planned schedule and budget
- Significant cost savings realized across six teams
- Faster, more responsive customer service
- Improved efficiency and CSR productivity
- More consistent regulatory compliance
- Multiple systems migrated and integrated on planned schedule and budget
- Significant cost savings realized across six teams
- Faster, more responsive customer service
- Faster, more responsive customer service
- More consistent regulatory compliance
Solutions
The solution helped Intel to provide its employees with a more pleasant and productive work environment, from ensuring energy-efficient environmental controls to the avoidance of frustrations associated with parking and cafeteria queues or searching for workspaces, resulting in improved employee retention.
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