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Increase efficiency in medicare claims processing

Use an omnichannel customer engagement platform to streamline

Genesys Enterprise Workload Management can match each task type in the overall claims process with the right priority and person to handle it. Based on a combination of skill levels, task complexity and SLAs, our solution flexibly determines whether tasks can be selected by a staff member or proactively assigned based on availability (or some combination of the two).

Increase efficiency medicare claims processing sb resource center en

Most organizations, especially those handling millions of Medicare and Medicaid claims, are unable to effectively manage tasks and distribute work to the right resources in a timely and costeffective manner. These inefficiencies not only keep you from achieving your organizational goals, they also significantly impact customer satisfaction.

Genesys, the omnichannel customer experience and contact center solution leader, has helped a number of government agencies improve both efficiency and customer satisfaction with the Genesys Customer Experience Platform.

Optimize internal processes

In the typical organization, offline work items are unmanaged, and the time required to address them is not tracked. This makes it nearly impossible to optimize the productivity of your staff and can result in frequent backlogs. Work items are kept in a multitude of applications or systems, and productivity drops when your employees are searching for the next task to tackle or, worse still, “cherry picking” items they enjoy instead of handling the most important ones. Genesys research reveals that backoffice employees spend 28% of their time performing unproductive tasks.

Genesys solutions for enterprise workload management help you:

  • Prioritize tasks based on value and staffing.
  • Ensure service delivery levels.
  • Analyze processes for efficiency and insight.
Prioritize tasks based on value and staffing

Aligning claims processing priorities with your organizational objectives is the key to efficiency. For example:

  • Which claims should get the highest priority?
  • Which tasks are in jeopardy of missing due dates?
  • Which appeals processes might need specialized resources?

Without a careful, rules-driven approach to task assignment, inefficiencies are virtually guaranteed. And with no visibility into which claim is with which agent—and when the agent viewed the claim—it’s virtually impossible to monitor the effectiveness, efficiency and skills of your staff.

Genesys Enterprise Workload Management can match each task type in the overall claims process with the right priority and person to handle it. Based on a combination of skill levels, task complexity and SLAs, our solution flexibly determines whether tasks can be selected by a staff member or proactively assigned based on availability (or some combination of the two).

Ensure service delivery levels

The Genesys Enterprise Workload Management solution can automate processes to ensure that you meet service level objectives, contract agreements and performance objectives. For example, if your goal for initial processing time is 45 days, any unprocessed claims nearing that deadline could automatically be prioritized at the top of the task list.

Analyze processes for efficiency and insight

By seeing and understanding internal processes as they happen, you can identify unique opportunities for savings. Real-time and historical reporting within Genesys allow you to track, analyze and continually optimize claims processing as well as gain visibility into important trends in your constituency that you otherwise would not have seen.

Improve the pre-claims experience

Improving self-service and assisted-service offerings can streamline claims management— before a claim is even filed. Filling out Medicare forms requires specialized knowledge, and those who are new to the process frequently make mistakes.

You can help your providers and customers by:

  • Offering in-context web chat and the ability to co-browse with beneficiaries, providers and suppliers to complete online forms faster and with fewer errors;
  • Providing personalized status updates via a sophisticated IVR, which can reduce call volume and allow your staff to handle more complex issues;
  • Providing the ability to schedule a callback at a time convenient for both parties—with choices provided by phone, the web or through a mobile app—which increases the likelihood of issue resolution;
  • Ensuring that all of the relevant information travels throughout the customer interaction, regardless of communication channel, so the responding agent automatically receives the full context—what we call “omnichannel engagement;”
  • Proactively notifying providers or beneficiaries when errors or omissions are spotted— Twitter, Facebook, and mobile messaging to beneficiaries can include a link to a selfservice location or web page with instructions or updates;
  • Communicating with your customers through the channels of their choice;
  • When optimization processes are in place, tasks are streamlined, employees are empowered and customers receive consistent experiences across channels.

Advantages of Genesys

Genesys gives you:

  • Single, comprehensive system of engagement
  • 360-degree visibility and operational control for all customer engagements
  • Integrated omnichannel workforce optimization suite
  • Open and highly scalable platform
  • Consistent, global operational control

Let us show you how we can help your organization.

By seeing and understanding internal processes as they happen, you can identify unique opportunities for savings. Real-time and historical reporting within Genesys allow you to track, analyze and continually optimize claims processing as well as gain visibility into important trends in your constituency that you otherwise would not have seen.

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