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CareFirst BCBS’s March Towards Digitizationof Sales and Onboarding Processes10/02/17 Jerome Mathias, Director, Sales App Dev & Support, CareFirst BCBS Alok Mandal, Principal Architect - Technology, Cognizant
Cognizant at CareFirstOptimized business process to 15 mins time to generate Quote(reduced from 5 days)Automated claims processAchieved 60% efficiencyLegacy Claims ProcessingGroups Individual MarketsIntelligent routing & automationbringing in 750K of savings / yearPega Deployment Tool E-CommOperationsClaimsSales QuotingEnrollmentsAutomated Enrollment Invoices 820 PaymentProcessing Renewals Contract Generation ProductComposerReduced enrollment fallouts by 75%through SLA-driven workflow automationCare ManagementPrior Authorization Provider Inventory andCredentialingSelf-service & digitization enabling StateCompliance (MHCC), CAQH integrationand direct authorization updates
Prior State – Disparate Systems and DataApplication formreceived in paperCompilingContracts dataManual keying inof dataExecutiveManagementCustomer ServiceMarketingLegalForm Submission tem 1Brokers provideinformation toenable quotingEnrollmentSystem 2OperationsBenefit CoderLegacy SystemsReference for Product Information
Vision01Accurate Quoting & Account SetupDisparateOperationalProcessesacross ASU’sMultipleSources ofData02Centralize Product/Benefit Setup03ModernizeContract fied e-CommunicationsWeb & Mobile AccessibilityOnboard Trading Partners SeamlesslyRefined Business & Elevated ROI
ProgressionINCREMENTALCLOUDSmall & Medium GroupStreamlining and Mobile enablement ofQuoting, Account setup and Enrollmentprocess.SOCIAL MEDIAIndividual MarketsExtend Workflows for Over 65 ProcessingBOTSMACHINE LEARNINGProduct ConfigurationProduct Implementation WorkflowBroker DashboardSalesforce IntegrationInstant Onboard : Trading PartnersCustomer Service InquiryExchange IntegrationEnd to End Status TrackingFeed Product Information to DownstreamApplicationsExchange IntegrationAutomated Deployment ToolACA MandatesEXECUTIONAncillary FunctionsACA MandatesMid Market AutomationLetter GenerationOver 65 EnrollmentsOperational ImprovementsRenewalsQuoting & Account ActivationReal Time Quoting & EnrollmentCentralize Benefit ConfigurationE- Communication by ConsentAutomate Rate Load Into FacetsSocial Media FeedbackCentralize Products & Rate DataContract Generation
Today’s LandscapeHealthcareExchangesQUOTING & OTSSOCIAL l Groups (2-50)Medium Groups (51-199)MACHINE LEARNINGPRODUCT CONFIGURATIONExecutiveManagementMedical / Dental / Vision / PharmacyMedical / Dental / VisionIndividual, Small, Medium, Large GroupsMarketingProspect CreationNetwork & Grouper SetupGroup CreationBenefit Setup & LimitationsRenewalsQuote GenerationLegalProduct & Plan CreationIndividualMedical / DentalInheritance & Mass UpdateNew Applications, Change Requests & Rate RetrievalMandatesConfiguration WorkflowOperationsORCHESTRATORCONTRACT GENERATIONCD, Small, Medium GroupsContract Execution and ManagementBenefitCoderELECTRONIC COMMUNICATIONUnderwritingMember, Brokers and EmployersElectronic Communication by ConsentEnrollment SystemCustomer Service
CareFirst BCBS's March Towards Digitization of Sales and Onboarding Processes 10/02/17 Jerome Mathias, Director, Sales App Dev & Support, CareFirst BCBS . Vision Disparate Operational Processes across ASU's Multiple Sources of Data Intricate Onboarding . Product & Plan Creation PRODUCT CONFIGURATION Medical / Dental / Vision .
