deanne branham healthcare payer crm solution set 8.x
Post on 24-Dec-2015
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Deanne Branham
Healthcare Payer CRM Solution Set 8.x
Objectives
• Understand what a solution set is and why it is important
• Understand the Contents of the Healthcare Payor CRM Solution Set
• Embedded Best Practices in the Healthcare Payor CRM Solution Set
Solution Set Definition
What is a Solution Set?• What we sell (customer-centric solution, not Oracle-centric product)• Along with tools to help us sell, including:
• Positioning slides, including market drivers, corporate initiatives, and solution set alignment
• Discovery questions• Solution pre-configured demo, demo guide, slides, and script• Executive dashboards• ROI/TCO models• Value proposition• Reference architecture / solution map• Customer references
• Solution Set functionality consists of some combination of industry specific sales, service, marketing, analytics, and master data management, along with typical integration definitions
• Positions Embedded Best Practices and Out of Box Functionality to Avoid the “What do you want Siebel to do?” Implementations
Healthcare Payor CRM Solution Set
Overview
What is the Healthcare Payor CRM Solution Set 8.x?
• History• Created in version 7.8
• Created Embedded Best Practices for:
• Sales and Broker Portal• Service and Analytics • Enhanced with New
Functionality Over Time• Contains ABSOLUTELY
No Scripting (VB or Java)• All Scripts
Encapsulated in Business Services
• Technical Content• User Interface (Form Applets
and Web Templates)
• 237 applets• 48 business components• 144 views
• 4 SmartScripts
• Claim Appeal• Small Group Quote• Individual Quote• Individual Application
• 39 Workflows
What is the Healthcare Payor CRM Solution Set 8.x?• How many business flows/Best Practices does it contain?
• Marketing• List Import• Campaign Management• Campaign Execution
• Sales• Hybrid solution with OnDemand• Large Group Sales business process with Product Configuration• Small Group Sales business process• Telesales Individual Sales Process• Renewals• Agent Portal
• Service• Member Services (6 Transactions) with AUTO NOTE GENERATION• Claims Adjustment• Member/Provider Portal
• Healthcare Analytics• How often it has been shown
• BCBSND, Humana, IBC, CBC, Premera, First Care, Assurrant, etc…….• Sales Revenue achieved from solution set
!!Over 10M in License Revenue with Q4 projection!!
Embedded Best Practices
Large Group Business Process
Demo Scenario 1: Large Group Flow
Profile of Prospect (Bayside Trading Company):• Large Group• 5500 Employees• Lost to competitor 2 years ago because of no online enrollment• Just Received RFP
Objectives :• Manage all activities from opportunity to implementation
Opportunity ManagementLead Management
Start Proposal Process
GenerateQuote, send toUnderwriting
GenerateQuote, send toUnderwriting
Review Acct
Structure
Review Acct
Structure
ResearchCompetitive
Situation
ResearchCompetitive
Situation
Assign/ConfigureProducts
Assign/ConfigureProducts
GeoAccess
GeoAccess
BusinessInsight
BusinessInsight
ReviewOpportunity
Details
ReviewOpportunity
Details
ResearchCustomer &
Broker
ResearchCustomer &
Broker
ConductMeetings, update viaBlackBerry
ConductMeetings, update viaBlackBerry
AdvanceSales Stage
AdvanceSales Stage
Assign workto Team
Assign workto Team
Underwriting
AssessClaim
History
AssessClaim
History
Perform Rating,Submit
To ProposalTeam
Perform Rating,Submit
To ProposalTeam
ReviewActuarialReports
ReviewActuarialReports
Underwriting
EligibilityAnd
Exclusions
EligibilityAnd
Exclusions
Present Final Proposal
Review ProposalReview Proposal
Proposal Generation
Review Work,Generate Proposal
Review Work,Generate Proposal
Send ProposalTo Salesand/orBroker
Send ProposalTo Salesand/orBroker
Enterprise Roles
Support/Proposal Team
Sales Representative
Underwriter
Broker
Executive
Sales Sales, TAS/Solution Sales
Sales, Group Policies, *Configurator Sales, Extension to Rating Engine
Sales, Extension to Rating Engine Proposal Presentation
Workflow, Sales
Healthcare Payor: Opportunity to Proposal (Large Group)
CLICK
Tom can run a Geo Access report to assess the WellPoint network coverage for the proposed account’s employees.
CLICK
Tom can enter the set of products the customer is interested in. He can then click the Create Quote button at the top of the screen start the Quoting process.
CLICK
Based on the information entered in the Opportunity record, a Group Policy record is created in the status of “Application”. Tom can drill directly into this quote.
CLICK (2)
CLICK (1)
Drilling into the Quote takes Tom to the Group Policies screen
Tom can upload the initial census data and submit this application to Underwriting. He changes the substatus and clicks Submit.
CLICK
After submitting the application, the fields are grayed out to prevent changes once the application is in Underwriting.
Tom can click on the Inbox tab to view the handoff of work from himself to the Underwriting group.
Tom can see the work item now assigned to SWALTERS; he can enter comments to make sure Steve processes the work quickly.
Underwriting Submit
Underwriting Submit
CLICK
Steve Walters in Underwriting has this new Policy application delivered to his Inbox. Steve can drill directly through to the work item.
CLICK
Steve can review the proposed products for the customer. If needed, Steve can receive guided assistance by clicking on the iHelp button at the top.
CLICK
iHelp provides inline assistance for complex processing. iHelp also allows users to see where they are in the current process. Hyperlinked items in the iHelp pane guide the user to the next step in the process. In this case, Steve clicks on the Exclusions item in step 4 to go directly to this tab.
CLICK
Steve can capture any applicable exclusions, then click through to capture Eligibility requirements.
CLICK
Steve clicks on the drop-down arrow to expose more available tabs for the Underwriting process. He clicks on the Group History tab to view claims history.
CLICK
Steve sees Large Claimant History information to further assess risk. He can then click again on the arrow to expose the Underwriting Reports tab and attach any relevant report.
CLICK
Once Steve attaches the Loss History Report, he can perform a final Rating. He clicks back on the Plan Design tab to access rates and the interface to WellPoint’s Rating engine(s).
CLICK
Steve can perform final customizations on the proposed plan. This brings up a set of guided screens that allow Steve to select product/plan attributes with guided assistance and automated enforcement of WellPoint business rules.
Selection of product attributes triggers automated rules. In this case, selection of a $500 In-Network deductible ensures that the Non-network deductible is higher than $500.
CLICK
After configuring the product attributes, Steve can view the Product Classes.
CLICK
Scrolling down further on the page, Steve can enter information about each Class, along with prices for each Rate Band. These rates can be entered manually, by spreadsheet import, or automatically by direct interface into a Rating engine. Siebel also maintains each category of rate (Bid, Sold, etc.)
CLICK (1)
CLICK (2)
Steve changes the status to Proposal Submit. This sends the work to the Proposal team; the fields are grayed out, allowing only the Proposal team to change any values.
To monitor Sold Case implementation, managers and executives can see how quickly work is progressing through the defined process
Indicators can be color-coded to quickly determine if work is moving according to WellPoint and/or customer objectives
Dashboard users can drill into data behind the chart to see specific cases that are in a specific stage and take action if necessary.
CLICK
Complete Healthcare Solution PlatformLeverage Applications as You Need Them
Siebel Healthcare Base Applications
Siebel Sales: Individual, Small & Large
Group
Siebel Marketing: Target Consumers, Groups,
Agents/Brokers
Siebel Service: Members, Groups, Providers,
Agents/Brokers
Siebel Healthcare Self-Service Solutions
• Siebel Agent Portal• Siebel eCommerce• Siebel eBilling
• Siebel Group Self-Service • Siebel Member Self-Service• Siebel Provider Self-Service
CRM HR Products Benefits Membership Claims
IntegrationIntegration
Siebel Healthcare Analytics
•Siebel Executive Dashboards•Siebel Sales Dashboards
•Siebel Service Dashboards•Siebel Marketing Dashboards
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