Brexit and Its Impact on Customer Communications

Posted on March 27, 2023 by SmartComm

By Chris Murphy, Senior Director of Product Marketing at Smart Communications

The political and economic uncertainty surrounding Brexit – the UK’s exit from the European Union – is leaving thousands of organizations with a plethora of unanswered questions surrounding the possibility of significant commercial impact as well as an inability to adequately to prepare for the unknown. Companies are not only having to effectively react to the impact of leaving the EU in and of itself, but open questions remain as to the exact conditions of that exit. Many large UK-based companies have already sunk a combined $1.1 billion dollars preparing for GDPR, a future of similar of operational upheaval stemming from Brexit looks ominous.

Yet, despite so many unanswered questions, forward-thinking companies can respond to the uncertainty around Brexit by preparing for the one thing that they know will definitely come – change. This change is going to manifest itself in a variety of methods — the way that companies communicate with their customers, regulatory and compliance standards changes, as well as significant shifts in governing body oversight.

With many companies in the midst of significant digital transformation efforts and a renewed focus being firmly placed on customer experience, interruptions caused by Brexit have the potential to destabilize a lot of the stellar work that has gone into improving companies’ relationships with their customers. Customers will look to the brands that they do business with to provide them with a clear path detailing how Brexit will impact their ongoing relationship and require a clear communication strategy via their preferred channels of choice.

Even before Brexit, a Thomson Reuters study shows that financial institutions in the EU need to implement 44,000 regulatory changes per year; that’s one every 12 seconds.

It’s clear that Brexit will provide both challenges and opportunities to leading insurance and financial services organizations – both regulated and non-regulated – regarding their relationships with customers, internal stakeholders and regulators. As forward-looking organizations prepare for the upcoming raft of changes, leveraging a modern customer communications platform can empower businesses to move with both speed and agility – helping them to better navigate the uncertainty that lies ahead. Below are a couple of questions organizations should ask to help understand if it’s time to rethink your customer communications strategy.

How do I remain compliant and maintain consistency across communications?

As a result of Brexit, some organizations will be impacted by legal entity changes requiring updates across thousands of different communication documents. A modern customer communications platform equipped with a centralized relationship map with shared content will identify exactly where each content asset is currently being used and allows updates to be made once and shared across all dependent communication templates.

For existing communications, do I have to rely on IT to make any changes?

With a heavy reliance on IT, many legacy communication platforms require a large investment and long lead times in order to update their mission-critical documents. A platform that is designed to leverage shared content and can be used by business users across various departments can not only speed up the efforts of these critical updates but will allow IT to dedicate more time and resources toward other strategic projects.

Can I work collaboratively on communications across multiple stakeholders?

Depending on Brexit’s outcome, customers could become subject to existing British laws or will remain part of current European laws and protections – all of which will need to be communicated to customers in a timely and consistent manner. Collaboration across IT, legal and compliance, marketing, CX, and line-of-business owners will be imperative to achieving the required alterations to communications.

One insurance company is saving thousands of hours a year through business user ownership of their templates.

Do I have the speed and agility to perform required changes?

Speed and agility are the hallmarks of a successful digital business. But they will also be required to ensure compliance with mandated changes to avoid financial penalties. The ability to elastically scale on a modern cloud-based communication platform will afford organizations the speed and agility required to not only respond to required changes brought about by Brexit but will also effectively launch new products and services in a fraction of the time that legacy communications platforms allow for.

It’s clear Brexit will introduce a multitude of organizational, economic, political, and jurisdictional changes for organizations. Being able to effectively navigate these changes in an agile fashion to maintain transparency and trust with your customers through this period is going to be a strategic imperative for every organization.

Smart Communications is the leading cloud-based customer communications platform. Contact us to learn how we can help you navigate Brexit and the impact it will have on your customer communications strategy.

A Scalable Approach to Claims Correspondence for Insurance

Posted on March 27, 2023 by Mary Featherstone

By: Ruth Fisk, VP Insurance Marketing at Smart Communications

With customer expectations higher than ever and climate change and other environmental factors intensifying the likelihood of losses – and subsequently claims – there is no better time for insurers to rethink their claims correspondence solutions.

Many insurers, unfortunately, have built siloed solutions to produce claims communications – ultimately leading to internal inefficiencies, compliance risks and an inconsistent, disjointed customer experience. However, every interaction an insurer has with a customer is an opportunity to shape the overall experience – and the multiple touchpoints throughout the claims process can make a customer’s experience a smooth one. This puts pressure on insurers to effectively orchestrate interactive, personalized two-way conversations, as opposed to the disjointed, one-way communications of the past.

In the infographic below, we provide insurers with one view of all of the unique customer interactions that span across the entire claims process. We also highlight how a modern customer communications platform like the Smart Communications Conversation Cloud^TMcan enable insurers to seamlessly work throughout the claims process – key to digital transformation in the insurance industry and much more efficient than maintaining several disparate technology systems.

Infographic illustrating the claims correspondence process for insurance industries:

To learn more about how Smart Communications enables insurers to engage in SMARTER customer conversations, visit https://www.smartcommunications.com/industry-solutions/insurance/.

5 Key Trends Impacting the Insurance Industry

Posted on March 27, 2023 by SmartComm

By: Ruth Fisk, VP of Industry Marketing, Insurance at Smart Communications

The insurance industry has been under pressure to innovate for quite some time. However, the implications of the global pandemic have only accelerated the need to be more agile and responsive to customer demands. And as we enter a post-pandemic world, insurers are continuing to pivot to new ways of working and engaging with customers.

As a result, carriers are increasingly investing in digital transformation initiatives to meet the needs of both employees and their end customers. In this post, we dive into how the ongoing impact of the pandemic, changing customer expectations, and digital transformation will continue to impact the insurance industry, plus strategies for success in the months and years ahead. Read on to learn more about key insurance industry trends customers expect from their insurance carrier.

Work from Home (WFH) impacts employees and policies

Over the past 12+ months, massive shifts in where people work have forced insurers to figure out how to make their own workforce productive while simultaneously maintaining a positive customer experience. While digital solutions enabled the shift to WFH, they also exposed inefficiencies in existing processes.

According to Tom King, Director of Insurance at Salesforce, “In the insurance industry…there are a tremendous amount of manual processes and workarounds. Employees want to do the right thing and as a result, have been able to get work done despite cumbersome systems. The pandemic has forced business leaders to look in the mirror and address these issues once and for all.”

Business leaders must ensure they make the remote work experience as seamless and efficient as possible, and employees must be able to collaborate across systems and teams while ensuring security and compliance standards. This means continuing to implement processes that allow employees to be successful from home and investing in the necessary technology to support a digital-first approach.

Rising customer expectations highlight digital deficiencies

Anything consumers want is now only a few taps or clicks away. With COVID-19 forcing many to rely solely on digital means to meet even their most basic needs, the world has seen a seismic shift. Now customers have heightened expectations for anything and everything to be digital, including insurance.

This puts digitally deficient insurers in a bind, as customers increasingly expect everything to be easy and transparent. Today, when customers purchase new policies or make claims, they expect clear communications at every stage of the journey, including self-service tools they can use to monitor progress themselves. Today’s consumers want digital solutions that can provide the right answer, quickly.

Personalization matters more than ever

In addition to ease and convenience, consumer apps also excel at personalizing experiences and making processes simple. Salesforce’s Tom King suggested, “Insurers specifically will be measured by how well they know their customers. Experiences need to be tailored to the individual, and for this to happen the business needs to have better visibility into the customer.”

But personalization is easier said than done. It depends on great data—collecting it in a way that is frictionless for the customer, and then leveraging a technology platform that can put it to use. For business leaders to achieve the agility and flexibility that today’s market landscape requires, they need to move to a cloud model and leverage open APIs. This will allow data from core systems, third-party solutions and more to be incorporated into tailored, personalized customer experiences.

Launch new insurance products that showcase best-in-class technology

Insurers are looking to capitalize on the “next normal” by developing and launching new products that meet the needs of the post-pandemic consumer. Insurers are piloting new types of coverage, services and distribution options to address a more volatile marketplace. This year, many young drivers will hit the roads for the first time, and homeownership will become a reality for many in the midst of a red-hot real estate market. SMART insurers will tailor their offerings to gain market share among this tech-savvy crowd.

Brian Vannoni, Director of Market Insights at Guidewire Software, shared his thoughts on this trend, “There will be a next normal for society and for insurance. It will include digital-first, omnichannel engagement, a remote work environment that requires internal digital processing and closed-loop analytics and a new way of engaging with customers and employees.”

The trick is that new products require a robust technical infrastructure. New offerings will need processes for collecting information, connecting with core systems and communicating with clients for everything from issuing a quote, to onboarding and providing ongoing customer support. To accelerate innovation and decrease time to market, insurers will invest in low-code, flexible technologies that support this greater agility.

Investments in digital communication technologies empower human connection

One of the big lessons to come out of the pandemic is the importance of embracing the human side of the business. Ultimately, customers want to feel like a name, not a number. But traditionally, insurers have been a bit distant when thinking and even talking about their customers. “In the insurance industry, when you buy a policy, you are a ‘policyholder.’ When you make a claim, you are a ‘claimant.’ You are never a ‘customer.’ The language we use reflects a mindset, and this mindset needs to shift to be more customer-centered,” noted Seth Rachlin, Ph.D., Executive Vice President, Chief Innovation Officer at Capgemini.

Even in a world gone digital, insurers have an opportunity to truly connect with their customers as people, wherever they are and however they choose to interact. The right technology platform is crucial in enabling these experiences – one that enables two-way, interactive conversations with customers at any time on any device.

Interested in learning more? Smart Communications recently collected insights from industry thought leaders to uncover major insurance industry trends that will impact how businesses communicate with their customers. Check out the full eBook today!

Work SMARTER, Not Harder: Enhancing CCM Efforts with Forms Automation

Posted on December 12, 2022 by SmartComm

By: Sally Schulte, Product Marketing Director at Smart Communications

Consumers today expect to do just about everything digitally — from filing an insurance claim and managing personal finances to making medical appointments. That’s why the move to digital-first customer interactions was happening even before the global pandemic, which threw digital transformation initiatives, like forms automation, into overdrive. In fact, a March 2022 IDC survey found that 71% of business are implementing a digital-first strategy due to the pandemic’s lasting impacts.

As a result of this widespread digitization, enterprises must rethink customer engagement. The days of companies only offering one way for customers to communicate with them, usually involving paper, are long gone. Today, customers expect more. They want to be able to initiate interactions with a business, start and stop at their convenience and even switch between channels and devices without having to start over. That means enterprises need to make interactions two-way, digital and conversational.

To meet customer expectations, many organizations have already adopted customer communications management (CCM) platforms. But one category of customer “communications” that companies often overlook, and under-optimize, is the form processes required to interact with them. Adding a forms automation solution enhances CCM efforts and fully optimizes the end-to-end customer experience (CX) by turning static, one-way processes into dynamic digital conversations.

Investing in a smart forms automation solution can make a huge difference to CX. Digitizing forms-based processes is not just converting paper forms to fillable PDFs and putting them on a website. True form process automation creates interactive, personalized experiences that consider known information, such as the customer’s personal details, medical history, insurance policy information and more. The digital journey should accommodate the end user’s timeline and device preference, letting them start on one device, leave, and pick up right where they left off on another.

Most importantly, a strong forms automation solution ensures that enterprises collect the most accurate data from every interaction. When paired with a cloud based CCM solution, this allows businesses to deliver the most tailored, personalized interactions in real time. Let’s look at some of the ways web forms automation and forms management software can benefit CCM efforts and the business at large.

Mitigate Risks for Data Breaches and Errors

Many industries have long relied on paper forms for key operational processes — things like loan applications, insurance claims documentation and reimbursement for medical expenses. But paper forms bring inherent risks that can be avoided with digitization. Paper forms that are mailed in or scanned and attached to an email are much less secure than digital forms – running the risk of unauthorized access that exposes PII (Personally Identifiable Information) and can result in hefty fines and damage a company’s reputation. Paper forms, or electronic forms that are stored in a database or on a hard drive, can easily become compromised, lost or breached by hackers. And when completing forms manually, even minor clerical errors can significantly slow down customer service processes or, worse, prevent a needed service from being provided to a customer.

Automated enterprise forms management helps businesses mitigate these risks. The data from digital forms can be easily transferred, stored and managed by existing core systems – aligning with any corporate data strategy. Choosing a cloud-first solution provides the added benefit of scale, reducing ongoing dependencies on internal IT resources. Process automation, including pre-population of forms with personal information pulled from existing core systems, minimizes the risk of errors, accelerating resolution and improving the overall customer experience.

Regarding risk, it’s also important to discuss compliance regulations. With digital form content, business owned form processes can be quickly and easily updated with content that is impacted by changes to local or federal regulations—securing compliance. And overall efforts related to risk mitigation closely align with broader CCM initiatives by making sure businesses have the data they need to optimize CX, such as customer preferences. Partnering with a vendor that offers both CCM and forms automation software makes it possible to stay one step ahead, especially when regulations vary by region. Again, it’s about working SMARTER — not harder.

Save Time and Money with Forms Automation

It’s a simple fact that manual processes can be slow and time-consuming, and can be especially cumbersome when it comes to gathering and acting on customer data. With remote and hybrid work here to stay, digital forms increase workplace efficiency by eliminating the need for employees to re-key information from paper forms or, worse, take data entered in one system and have to manually enter it into another. A fully integrated, cloud-based solution means that team members across departments and locations are all working from the same information — no need to worry about someone making a decision based on outdated information by mistake.

Automating forms-based processes is a win-win for both customers and business users. Transforming things like intake questionnaires, claims filing or loan applications into intuitive, guided digital experiences is faster, easier and much more secure. And it improves the employee experience because they’re not spending hours on the repeat tasks associated with manual, paper-based processes. Business users can get new projects to market faster and maintain existing projects quickly and easily. With the added flexibility forms automation provides, enterprises can reallocate and reduce the need for IT resources. Increased efficiency can even lower the cost of overtime, additional employees and other expenses related to manual forms management.

Forms Automation Can Enhance Enterprise Customer Communications

The goal for enterprises today is to deliver digital, omnichannel communications at scale. Customers want to be able to get things done on their own time and their own terms. By combining a cloud-first CCM solution with a sophisticated forms automation solution, enterprises can empower customers to self-serve — when, where and how they prefer. Incorporating data from core systems in real time allows enterprises to deliver communications on the customer’s preferred channel quickly and efficiently. Plus, taking an adaptive interview approach lets businesses confirm previously known information while also collecting new data.

This type of dynamic, two-way interaction leads to more personalized conversations that can be tailored to individual customer needs, making their lives easier. At the same time, it enables businesses to make data actionable and scalable, enhance communications and support faster resolution and decision making.

Purpose-Built for Today’s Enterprise Needs

At Smart Communications, we understand the importance of automating everything from basic tasks to sophisticated and complex processes. Our integrated solutions, including SmartIQ forms automation and SmartCOMM customer communications management, work together and connect to existing systems to deliver intuitive customer experiences and dynamic communications. By bringing data together, enterprises can gain a complete, contextual view of customers and remove friction with a single, powerful CX ecosystem.

Get in touch today to find out how SmartIQ enables enterprises to improve forms-based processes and empower interactive, two-way conversations.

3 Ways Insurers Can Leverage the Cloud to Close Gaps Between Customer Expectations and Their Experiences

Posted on October 11, 2022 by SmartComm

By: Ruth Fisk, VP of Insurance Strategy at Smart Communications

Although the insurance industry has centuries-old roots, the world in which we currently live requires a modern approach to the technology, systems and processes insurers use to provide a great, end-to-end customer experience. Thankfully, there are such solutions on the market that can bridge the gap between customers’ expectations and their experiences with insurers.

While insurers have undoubtedly evolved the way they deliver products and services to customers, there’s still a fair amount of work to be done as technology becomes increasingly sophisticated and customers’ behaviors – and expectations – continue to evolve. In fact, Deloitte indicated that “In setting strategic plans, investment priorities, and budgets, insurers should therefore strive to maintain the momentum of creative adaptation established over the past few years, accelerating upgrades in systems, talent, and culture while becoming increasingly proactive, innovative, and customer-centric.”

It’s clear that organizations interested in staying ahead of the game must leverage best-in-breed technology solutions to digitize and optimize key touchpoints across the end-to-end customer experience. As insurers set their priorities for 2023 and beyond, we explore three ways insurers can deliver on customer expectations and provide the experiences they expect:

1. Use Pure-Cloud Solutions to Power Core Operations

Legacy platforms lack the necessary interoperability that’s needed to power core operations used by most insurance organizations. What’s more is that outdated systems offer limited APIs, making them incapable of integrating with key elements of a sophisticated technology stack. Ultimately, a lack of integrations can negatively impact the customer experience as insurers won’t have the necessary data across multiple customer touchpoints. This inhibits the ability to provide personalized, omnichannel communications and garner deep insights into how, when or why customer expectations are not being met.

On the other hand, pure-cloud solutions help to modernize IT operations—a key initiative insurers need in order to adapt more quickly to changing market demands and deliver more value to policyholders. Equipped with a suite of API integrations, solutions like the Smart Communications Conversation Cloud offer insurers the ability to connect all data, applications and history. With actionable data at their fingertips (made possible by using cloud solutions and strong APIs), insurers can realize the scalability needed to deliver personalized interactions across all devices and channels—a feat that is impossible to achieve with a manual approach. This also helps insurance companies prepare for the future and increases their internal efficiencies..

Interested in learning more about how Smart Communications can help insurers deliver SMARTER customer conversations in the cloud? Read the white paper for more.

2. Cater to a Digitally-Savvy Customer Base

Meeting the demands of today’s (and tomorrow’s) digital-savvy customers requires insurers to adopt the technology and processes that power agility and scalability. In a recent report, Tom Super, head of property and casualty insurance intelligence at J.D. Power, stated, “The bar just continues to get higher for customer expectations around digital. And while many insurers are hitting the mark on the digital basics, few are using digital in new ways to drive growth and engagement.”

Organizations should continue investing in the delivery of two-way, interactive conversations that make possible a customer-centric experience which transcends the typical, one-way transactions most customers are accustomed to. Historically, insurers considered the print/direct mail communications they delivered very carefully—a method that was used to convey the brand and its product or service promise. Given the digital-native customers of today, insurance companies need the ability to deliver impactful, personalized and relevant conversations (two-way) in real time. This is a distinct shift from one-way, paper-based transactions (that is, no longer using the best-in-class printed piece) to digital interactions that will make or break a customer’s experience.

3. Prepare to Remain Agile

While there will always be a level of ‘unknowns’ in the business world, operating as an agile organization is a necessity. To do so, insurance companies need to focus on recruiting top talent, remaining compliant, becoming customer-centric and partnering with modern solution providers that remain on the cutting edge of technology and integrate with core systems of record in the insurance space. By bringing together best-of-breed technologies, enterprises can better respond to market demands in an expeditious and scalable manner.

As insurers explore technology options, one way to adopt a more digital-first approach in the near-term is to invest in low-code solutions. Adopting low-code, cloud technology is a competitive edge that can offer insurance organizations:

Operational efficiency
Speed to market
Cost reduction
Improved quality
Effective use of resources

But, the biggest benefit of low-code systems is that they can be implemented quickly and without added burden to internal IT departments. To be an agile organization that is positioned for the future, insurance leaders will need to continue prioritizing innovative investments.

RELATED READING | ‘2022 Forrester Consulting TEI:SmartIQEnables Cost Savings, Solves Business Challenges‘

Conclusion

Smart Communications is proud to see the growing investment in innovation across the insurance industry. As we anticipate the 2022 Guidewire Connections event in Las Vegas later this month, we’re excited to discuss the capabilities that more than 100 Guidewire customers have invested in to deliver SMARTER conversations across the complete customer lifecycle. There are several opportunities to engage with us at the show, including:

Join Smart Communications in the Ecosystem Demo Theater to watch live demonstrations of “Ready for Guidewire” offerings from PartnerConnect Solution partners. These solutions — developed by members of the world’s largest P&C insurtech ecosystem — are available in the Guidewire Marketplace.
Accelerating the Time-to-Value of Digital Platforms: Elements of Cloud-Native Success on Monday, October 24 at 1:15pm PST | Co-presented by Ruth Fisk, Vice President of Insurance Strategy at Smart Communications and Ralph Severini, Global Leader of Insurance Alliances at AWS, attendees will learn how leveraging cloud-native applications and integrations is critical to a foundation for future growth.
The Digital CIO: Taking Digital Innovation to New Heights with SmartCOMM & Guidewire on Monday, October 24 at 2:15pm PST | Ruth Fisk, Vice President of Insurance Strategy will moderate a CIO panel discussion on how providing a positive customer experience and core IT strategies can align, the role of cloud technologies and the future direction for insurance. CIO perspectives from Smart Communications customers include Amy Bingham from Pekin Insurance, Cam Loeppky from Wawanesa Insurance and Tim Hays from Mountain West Farm Bureau and 360 Insurance.

Visit the main Guidewire Connections 2022 page to learn more about the event or to get registered to join us in Las Vegas from October 23-26.

Provide the Ultimate Healthcare Customer Experience

Posted on September 14, 2022 by SmartComm

Provide the Ultimate Healthcare Customer Experience: The Guide to Member Engagement Strategies

By: John Zimmerer, VP of Healthcare Marketing at Smart Communications

In a world where everyone is always on the go and as technology becomes smarter, faster and more intuitive, consumers increasingly prefer—and expect—digital-first experiences.

For highly regulated industries like healthcare, the stakes are even higher. Everyday customer interactions can be stressful, making the experience that health insurers provide at every touch point more important than ever. Recent benchmark data confirms this – with 81% of consumers indicating that communications are important to their overall experience with a company.

Unfortunately for healthcare payers, the industry lags in digital adoption, which has led to both internal inefficiencies and poor customer experience. As they interact with other non-healthcare industries that have set the customer experience bar high, healthcare members may begin looking to competitors to fulfill their needs. According to the Forrester Customer Experience Index, healthcare tracks well below the averages of most, ranking tenth out of the 13 U.S. industries analyzed.

In Provide the Ultimate Healthcare Customer Experience, we will walk through:

Key customer experience trends in healthcare
How healthcare payers can increase member engagement via cloud-based technology
The importance of omnichannel customer communications
Why Smart Communications offers the most complete platform on the market to support leading health insurers’ business strategies

Changing Customer Expectations and Regulations Drive Trends in Healthcare

The past few years have amplified the need for improved customer interactions. Globally, businesses have faced—and in many ways continue to endure—disruptions on multiple fronts. Many employers have moved their entire workforce to function as fully remote teams while continuing to navigate what the “next new normal” of work might look like. While all of these macro forces were influencing organizations to rethink how to do business, customer demands for digital-first experiences continued to increase.

Compounding to this digital transformation, the healthcare industry saw new regulations put in place, including:

Interoperability, which is “the ability of different information systems, devices and applications (systems) to access, exchange, integrate and cooperatively use data in a coordinated manner,” according to HIMSS
Price transparency, which allows healthcare patients to know the cost of a medical service before receiving it
Value-based care, where healthcare providers and hospitals are paid based on patient health outcomes
Shift to Medicare Advantage and ACA plans, providing individuals with more choices of health plans to purchase

As a result of these ever-changing market conditions, even the U.S. Federal Government has come to understand the importance of how much the customer experience matters to consumers when choosing a healthcare plan: for the 2023 plan year, member experience metrics make up the largest percentage (57%) of star ratings for Medicare Advantage plans.

Customer Experience Trends in Healthcare

On the bright side, insurers are beginning to realize the importance of making the healthcare customer experience a strategic priority. Recent findings include:

More focus on improving customer interactions. A Forrester report revealed that 15 out of the top 17 health insurers have experienced as much as a 5% year-over-year increase of their CX index scores – in large part due to these concentrated CX investments.
Higher investments in “total experience solutions.” These “consumer engagement” solutions improve the experience for both the employee and the member and are one of the top investment targets for health payers, according to Gartner.
Stagnant budgets. The same Gartner survey revealed that healthcare payers are seeing the lowest technology budget increases of any other industry. Health insurers therefore must invest wisely, strategically selecting key areas to improve that maximize the impact on the customer experience while minimizing disruption to both their members and their own organizations.

So, how can health insurers set themselves up for success?

A cloud-based platform that optimizes the end-to-end healthcare customer experience provides the agility, flexibility and innovation that homegrown or legacy, on-premise systems cannot. Below, we will dive into the benefits of cloud for nearly every touch point in the member journey, plus how optimized member communications provide health payers with the competitive edge they’re seeking.

Convert One-way Customer Communications to Two-way Conversations

To positively impact the healthcare customer experience, payers need to focus their investments in transforming their member communications. Leading analyst firms like Forrester confirm this, with recent research indicating that one of the top drivers of delivering a better customer experience is related to improved member communications.

Forrester also cites consumer preferences like “respects me as a customer” and “effective website and mobile apps” as factors that positively impact health payers’ experience scores.

To do this, health insurers must keep member preference in mind – at every step of the experience. Members should be able to start and stop interactions across channels and devices without having to re-key information. Delivering communications based on channel preference is also a must, as 61% of consumers indicated that receiving messages on the wrong channel leads to frustration with a company. At the end of the day, effective member conversations require an efficient and accessible digital experience at every step of the process.

Unfortunately, traditional ways of communicating with members aren’t as effective as they once were. So, as insurers rethink the healthcare customer experience, that means reimagining how members interact at every touch point. A big part of this is shifting from one-way, transactional communications to two-way, interactive conversations.

Delivering personalized, relevant and compliant conversations at scale can feel daunting, but the health insurers that invest in pure cloud solutions that are purpose-built to optimize member conversations will be set up for success. Cloud platforms, like the Conversation Cloud^TM, enable quick innovation, agility, scalability – and most importantly allow health insurers to evolve and scale as members expectations change over time.

RELATED READING | INFOGRAPHIC: Optimize Member Engagement at Every Point of the Health Insurance Journey

The Conversation Cloud^TM for Health Insurers

The Conversation Cloud^TM from Smart Communications empowers insurers to maximize their investments in the healthcare customer experience. Whether transforming a micro moment, such as a member-submitted claim form; to improving the access to and readability of critical communications like an Explanation of Benefits; or to orchestrate an entire customer journey such as a claim redetermination, look to the Smart Communications Conversation Cloud.

To better understand how the Conversation Cloud provides improves and transforms one-way communications into two-way, interactive conversations that positively impact the customer experience, this article focuses on four key areas where health insurers can enhance processes today:

Collect: Improve Data Gathering
Communicate: Increase Member Engagement with Content
Collaborate: Redefine Stakeholder Engagement
Coordinate: Reimagine the End-to-End Healthcare Customer Experience

Each section of this article provides examples and information to help insurers identify possible areas of investment, and in the process convert traditional communications into real-time, two-way conversations.

Collect: Improve Data Gathering

As health insurance executives start to invest more heavily in digital, they want to ensure that their investments are making a difference.

In a survey of more than 100 health insurance and provider executives, respondents cited what their organizations are currently doing and where opportunities still exist for improvement. When examining these leading indicators that impact the overall strategy for digitization investments, it’s no wonder that “customer satisfaction” is at the top of the list.

Despite more priority and effort going into customer satisfaction, this ongoing goal is simultaneously an ongoing challenge. Several points of friction are still holding digital projects back from making consumers happy. As companies expand their investment footprint across online and offline touchpoints, removing those frustrations is even more essential.

The Impact of Forms Automation on the Healthcare Customer Experience

Forms are a great example of one important aspect of a larger member journey. At some point, insurers will need to collect personally identifiable and protected health information (PII and PHI, respectively) from members. Most of the time, it’s done via a form—like web “name, address, location” fields, a PDF document, or just simply a piece of paper.

RELATED READING: Optimize Digital Forms for COVID-19 Claims

One of the greatest points of friction for members is having to provide the same data—name, address, age, etc.—repeatedly within and across forms. Consumers have a simple request: ‘Show me you know me’. Healthcare companies most often already have the data through direct engagement, an employer, provider, insurer or relationships with third-party providers.

The first trick is in making the digital connection to existing data; the next is to use this data intelligently. That means using available information and logic to hide or show subsequent questions or input fields. It also means leveraging integrations with other third-party services (for example, autocompleting address information, scanning a barcode, validating bank or other account information, etc.) to significantly reduce customer effort and enhance the customer experience.

Challenge

Static forms and similar tools can be cold and off-putting, therefore becoming a barrier to good data collection. To state it bluntly: customers just won’t fill them out.

Solution

The Conversation Cloud allows health insurers to seamlessly collect customer information by transforming static forms-based processes into intelligent, conversational user experiences. SmartIQ^TM powers:

Adaptive interviews
Experience-driven interactions
Omni-device availability
Real-time data validation

How can insurers use forms automation to enhance the healthcare customer experience?

Submit/appeal a claim
Disclosure and consent forms
Prior authorization requests
Personal representative appointment

Interested in learning more? Check out four ways forms automation can enhance the healthcare member experience.

Communicate: Increase Engagement with Tailored, Omnichannel Content

Personalization is a prevailing tactic for healthcare’s move toward digital excellence, and it’s easy to see why: When consumers receive relevant (customized) content on the right channel at the right time, they’re more likely to act and respond.

The two most frequently used digital communications tactics in insurance and health organizations are personalized messaging and multiple format options to support delivery across channels.

Supporting omnichannel engagement can also help organizations make the transition to a self-service model. Customers overwhelmingly prefer a digital-first approach including apps or online portals that give them more autonomy.

RELATED READING: How enterprises can orchestrate effective omnichannel conversations, creating consistent, customer-driven experiences across channels.

As a result, healthcare members want options: mobile phones, tablets and wearables have created an “always-on” environment where they can get things done with a click of a button. Access to multiple channels—plus ever-increasing expectations—puts more pressure on customer communications.

Successful conversations require content that is readable and easy for the user to comprehend. To keep customers engaged throughout the process, communications must be tailored as much as possible to the individual reader. These all must happen in real-time and must be able to reference context from previous interactions.

Getting these conversations done correctly and with ease is crucial for successful interactions. As insurers are looking to align their business priorities with member expectations, it’s important to keep in mind that 60% of healthcare consumers recently surveyed indicated that improving relevance and personalization is a top priority.

Challenge

Though these interactions are often mission critical, delivering personalized, real-time, contextual communications usually requires the creation and management of complex IT processes.

Solution

The Conversation Cloud empowers health insurers to create and deliver personalized, contextual and compliant communications across preferred channels to improve healthcare customer experience and deepen loyalty with:

Omnichannel approach for customer-preferred devices
Templates and reusable objects for consistency and compliance
Integrations with systems of record to pull in data for personalization
AI to improve readability and provide engagement insights

Ultimately health insurers can leverage these Communicate features across use cases, including:

Enrollment (ANOC, EOC, SBC, etc.)
Onboarding (ID card, provider/pharmacy directories, etc.)
Utilization (notifications/reminders, care management plans, etc.)
Claims (EOB, EOP, letters, etc.)

RELATED READING | Exploring CCM solutions? The Ultimate Guide to CCM Software provides a high-level overview of CCM software, poses questions to ask when selecting a vendor and more.

Collaborate: Change Stakeholder Engagement

Customer conversations sometimes require interacting with multiple stakeholders in a nonlinear process. Often, interactions occur outside the company altogether, e.g., with partners or regulators. Unfortunately, many businesses do not have a way for stakeholders to collaborate on business processes, which leads to a disjointed, frustrating customer or employee experience.

As a result, many fail to provide a holistic view of who made changes to critical documents, including what and when these changes were made. Requesting signatures or additional information from relevant parties can be difficult and these outdated processes can make sharing confidential information a security concern as well.

Challenge

When multiple stakeholders are involved in a process, there is increased risk of error – or worse – compliance issues. Siloed systems and inefficient processes are also time consuming, open up room for version control issues and create poor member and employee experiences.

Solution

Not only can the Conversation Cloud help speed things up, but it can also make these multi-step processes easy and simple, which results in a more efficient and effective interaction for all parties involved.

Working in a secure, online environment eliminates version control issues and also helps ensure compliance standards are met. With the Conversation Cloud, health payers can negotiate and execute processes by negotiating and providing business-critical agreements across internal and external stakeholders using experience-driven workflow including:

Developing Plan Documents
Coordinating Plan Selection for Group Enrollment
Internal Review and Approval of Content or Communications
Regulator Review of Plan Documents
Negotiating Provider or Supplier Contracts

RELATED READING | Healthcare member communications are ripe for transformation – are you prepared?

Coordinate: Reimagine the End-to-End Healthcare Customer Experience

Health insurers must focus on orchestrated, omnichannel interactions that guide customers through critical processes and provide richer, deeper and more engaging experiences. By interacting with customers via their preferred channels, health payers can improve their overall experience and increase brand loyalty.

Smart Communications partnered with Forrester Research to examine the current state of customer experience in healthcare. This research found that although 63% of consumers want better-connected journey touchpoints to improve the member experience, 57% of health insurers are struggling with the ability to provide a seamless digital experience throughout a given customer journey. The research also found that payers provide poor personalization and that journeys involving forms are as troublesome for insurers as they are for members and partners:

By creating self-service workflows and connecting across organizational silos, insurers can help their customers get easy questions answered, or simple steps completed—such as benefit or claim inquiries—in as few (or preferably single) interactions as possible. Although this compression of customer journeys can cut out unnecessary steps or to remove delays, the underlying and greater emphasis is on removing friction that leads to a lowering of effort on the member’s part (i.e., the ease and effectiveness factors most favorably into the overall customer experience).

Members focus on moments that matter—the interactions and processes which are valuable or necessary to achieving a goal. As insurers are looking to make the healthcare customer experience more omnichannel, some key questions they should ask themselves include:

Are the required steps to achieve common goals clear?
Are we maximizing integrations to minimize customer effort?
Are there steps in critical customer journeys where customers are falling off or feeling frustrated?

Challenge

The business (and the customer experience) can be negatively impacted when processes break down or a deadline passes.

Solution

Orchestrate interactions to optimize the customer experience across devices and channels with:

Facilitated two-way conversations
Failover from preferred to fallback channels
Analytics and insight into member engagement

Enterprises should invest in and prioritize technology solutions that evolve and scale as customer expectations change over time, delivering interactive, two-way conversations that encourage engagement and brand loyalty.

Conclusion

Changing the Conversation in Healthcare

Health insurers can improve customer experience by removing friction and delivering personalized communications in real-time, via any channel, and at scale that are:

Customer-driven
Digital-first
Two-way
Relevant and contextual
Cloud-centric
Highly scalable
Omnichannel

At Smart Communications, we have the products, professional services and partner network to help insurers improve the healthcare customer experience, whether it’s to coordinate an entire member journey or to improve how customer information is collected. Contact us today to discuss where to begin.

Smart Communications for Healthcare

Certifications

The Conversation Cloud is the only secure customer conversation management platform to have achieved an independent third-party validation of HIPAA, PCI-DSS, ISO and SOC compliance.

Customers

Our healthcare customers choose Smart Communications because they want to improve their customer experience, or they want to improve their operational efficiency. As a result, SMART customers see CX improvements reflected in higher NPS, CSAT and CX Index scores.

Additionally, SMART customers are seeing operational improvements driven by hard and soft cost savings by moving to a centralized cloud-native platform.

Partners

The Future of Workers’ Compensation

Posted on June 20, 2022 by SmartComm

By: Ruth Fisk, VP Insurance Strategy at Smart Communications

A digital-first approach streamlines every stage of the claims lifecycle and leads to improved outcomes for all.

Introduction: Digitizing the Workers’ Compensation Claims Experience

When a worker is injured on the job, the employer’s first concern is their well-being. Additional considerations include ensuring the employee has a swift recovery, minimizing the personal fallout and mitigating future risks. Beyond that, employers also have to take into consideration the wider impact of workers’ compensation claims, to the business as a whole as well as to the ecosystem of involved parties that can be affected when an injured worker is unable to do their job. In addition to medical expenses and employee compensation, disruptions to productivity and continuity can strain resources within the company and impact the bottom line. The ripple effects can even reach the wider economy and society, making it all the more critical to focus on facilitating a rapid recovery. Employers have a vested interest in ensuring the employee regains their health and returns to work as soon as is feasible.

Workers’ compensation insurers are equally focused on supporting a timely and complete recovery for any claimant who is injured on the job. Resolving claims as quickly and efficiently as possible not only helps to minimize long-term impacts on the individual, it also helps the insurer minimize the financial impact. Reporting delays can increase costs as well as increasing anxiety and confusion for the claimant. In some cases, it can even lead to unnecessary litigation—an outcome all involved parties would prefer to avoid.

In today’s world, digitizing the workers’ compensation claims experience plays a crucial role in improving processes and outcomes for insurers, employers and injured workers. By automating manual, paper-based tasks, insurers can streamline every step of the claims management lifecycle and engage smarter with everyone from the injured employee to the rehabilitation specialist. But, this requires the right cloud-first solution.

To transform processes and deliver better outcomes, insurance organizations must adopt digital-first solutions and take a conversation-based approach. Moving to a dynamic, cloud-based customer communications platform makes every step of the workers’ compensation claims management process more efficient, from initial reporting through final payout and case closure. And with a single platform facilitating the multitude of forms and documents required in this highly-regulated space, case managers can keep both the recovery and resolution on track for faster results.

Let’s look at how the right solution can streamline and improve each stage of the workers’ compensation claims lifecycle, bringing outdated processes into the future.

Stage 1: Reporting the Injury

The first step of any workers’ compensation injury claim is reporting. During this critical stage, time is of the essence. It’s important for insurers to educate employees about their responsibility to report an injury as soon as possible. Faster reporting helps to accelerate the return-to-work process, reducing costs for both insurer and employer. In addition, injury reporting may be subject to government regulation, depending on the location. Failure to report an injury within a set timeframe may result in fines and other liabilities. A cloud-based solution can accelerate reporting by streamlining communications between the injured employee, the insurer and the employer.

Collect

A digital-first solution makes the claims intake process frictionless by collecting information using intelligent, adaptive forms, which are much more efficient than traditional paper-based processes. Integrating with core systems of record, insurers can pre-populate forms with company and policy information, making it easier for the employer to report the injury in a timely manner. The insurer can also use guided interactive forms to kick off the initial First Report of an Injury (FROI) assessment by guiding the employer through all of the initial claims data required related to the injury, ultimately providing a frictionless experience and expediting reporting.

Communicate

A modern solution should automatically generate any communications required by regulatory bodies, ensuring compliance. This includes exchanges between the injured worker, employer, case worker, medical provider and rehabilitation specialist, all of which are managed by the insurer. For example, an intelligent solution can create the FROI acknowledgment letter and provide the injured worker with a list of approved or preferred medical providers. It can facilitate more efficient occupational safety reviews.

Stage 2: Investigating the Claim

Next, claims are assigned to a case manager inside the insurance company. This person is responsible for gathering details from multiple involved parties, creating an accident summary, reviewing the material and photographic evidence and recommending preventative measures to reduce future loss. All of this needs to be done as efficiently and effectively as possible. An intelligent digital platform makes it easier for the case manager to carry out their responsibilities in a timely manner while also maintaining compliance.

RELATED READING | ‘Modernizing the Workers’ Compensation Claims Process’

Collect

Gathering additional material evidence from witnesses can be expedited by using adaptive forms that also allow for the easy inclusion of photographic evidence. Dynamic forms that are available on-demand allow for convenience and can even guide witnesses through the process.

Coordinate

If insurers don’t have an individual’s channel preference on record already, this is information they can collect early on. It’s important to ensure all future interactions are delivered on the user’s channel of choice, whether that’s email, mobile app, SMS or something else entirely. An omnichannel experience – where the individual can move from one channel to another without losing any historical context – is only possible with a cloud-native solution. Ultimately, an omnichannel experience helps to expedite the claims process and also provides a frictionless experience.

Collaborate

In a workers’ compensation claim, there are multiple stakeholders – both within and outside the insurance organization. As the case manager quarterbacks the end-to-end claims experience, working within a centralized, online environment makes it easier to get everyone to agree on what happened so the case can move forward. Plus, it mitigates version control issues and ensures all parties are working from the most recent documentation. Most importantly, however, digitized collaboration among all parties mitigates running into the regulatory or compliance issues that analog, manual processes can create.

Communicate

The case manager is also responsible for creating key documentation to be put into the case file and shared with involved parties. A smart solution streamlines and automates these critical processes, such as creating the accident summary after reviewing all the collected evidence. Case documentation is also subject to strict government body regulation, and automation can help to ensure compliance—unlike manual communications, which are tedious and error-prone.

Stage 3: Medical Management

In this stage of a claim, the medical provider is assessing the injury and establishing a treatment plan to facilitate the worker’s recovery. This includes things like evaluating if they need in-home help, rehabilitation and/or physical therapy. Depending on the details of the claim and the nature of the injury, medical management can involve any number of parties, making collaboration and communication vital.

Collaborate

Workers’ compensation insurers often have a medical officer who is responsible for liaising with physicians, rehabilitation specialists and other medical providers to determine the best possible treatment plan. The medical officer will review the injured employee’s medical records and may use evidence-based medicine to recommend procedures. For example, in the case of a slip-and-fall injury, they could review the insurer’s data for similar injuries to see where the insurer has had the most success expediting the return-to-work process.

The case worker, medical officer and providers must work together to establish a treatment plan and return-to-work date as soon as is feasible for the injured worker. Streamlining collaboration through a centralized, online hub helps to expedite this process to the benefit of the worker, the employer and the insurer.

Communicate

The medical officer and case manager also need to be able to easily and clearly share information with all involved parties. Injury details and medical records must be shared with the physician. Once established, the treatment plan needs to be shared with the injured worker so they can follow the prescribed treatment. A certificate of capacity may be issued, allowing the employee to return to work with certain restrictions.

Sharing the return-to-work date with the worker will help to alleviate emotional stress and anxiety due to loss of work and income. At the same time, knowing what they are working towards can be a motivating factor on the path to recovery. From the employer’s perspective, knowing the expected return-to-work timeline will help them allocate resources and plan accordingly.

Digitizing the workers’ compensation claims experience helps to streamline and expedite investigation processes and creates consistency across stakeholders, allowing for an interactive experience. A solution that enables omnichannel conversations gives the case manager the added advantage of being able to guide any involved individual to the most appropriate channel for a specific interaction, with seamless switching to maintain consistency.

Stage 4: Case Management

Once the treatment plan has been established, the insurer is focused on creating the best possible outcomes—for both the worker and the employer. The case manager and medical officer both need to be able to communicate, collaborate and coordinate efforts across all involved parties to facilitate these desired outcomes.

Collaborate

Determining the best way forward for the injured worker requires collaboration on many levels. The case manager and medical officer work with the claimant to help them create a self-determination plan, which is empowering and improves life outcomes in both the short- and long-term. They also need to work closely with physicians, rehabilitation specialists and other medical providers to ensure the employee’s recovery stays on track so they can return to work as expected.

If a specialist is needed to train the injured worker for a new job or for their return to work, the case manager will also need to create a rehabilitation plan. Connecting the injured worker with support groups can be beneficial in aiding a full recovery and alleviating emotional stress or anxiety. A centralized, cloud-based platform makes it easy for the case manager and medical officer to fulfill all of these responsibilities and keep track of multiple moving parts without letting anything slip between the cracks.

Communicate

It’s important to keep the lines of communication open throughout the claims lifecycle. The case manager needs to be in regular contact with the injured employee to ensure they are following prescribed treatment plans. And, the injured worker needs to be able to initiate conversations with the claims manager at their convenience, to ask questions and to make sure they’re getting the support they need.

A digitized, omnichannel solution allows for easy, seamless conversations on demand. Automating appointment reminders not only saves the case manager time for improved productivity, it also helps to keep recovery on track and on schedule – contributing to better outcomes overall.

Coordinate

During the ongoing case management stage, insurers must orchestrate communications between various involved parties and update back-end core systems, such as the claims handling system, to determine the best next steps. A purpose-built platform simplifies complexity and can even automatically update backend systems for a seamless flow of information.

Stage 5: Settlement

The final stage of the workers’ compensation claims process entails finalizing any remaining payments, establishing a return-to-work release and managing any long-term benefits. All of this needs to be completed before the insurer can close out the case.

Collaborate

The case manager must make sure all injury-related expenses are paid for, including medical invoices, drug prescriptions and other treatment costs. If the injured worker needs long-term care, payouts must be made to cover future expenses. And in the event that the injury resulted in death, the insurer is responsible for managing survivor death benefits. Centralizing all of these required steps makes it easier to close the case out in a timely manner while satisfying all policy and regulatory requirements.

Communicate

At this final stage, the ultimate goal is to establish a return-to-work authorization that determines when and where the injured employee can go back to work and share it with both the employee and employer. Digitizing communications makes this process more efficient.

Coordinate

To effectively close out the case, the case manager must orchestrate any final communications between involved parties and update the core systems. With a single, centralized hub that integrates with existing systems, the insurer has on-demand access to a comprehensive repository of all claims-related information and communications. This makes it easier to ensure regulatory compliance and helps to facilitate a complete recovery and get the claimant back to work sooner.

The Conversation Cloud^TM: Designed to Drive Better Outcomes

When it comes to digitizing the workers’ compensation claims experience, the Conversation Cloud enables insurers to turn static forms and disparate communications into dynamic, on-demand conversations across the claims management lifecycle. By using a pure cloud solution that integrates seamlessly with existing systems, insurers can dramatically simplify processes, expedite decisions, facilitate faster resolution and create better outcomes for everyone.

With the Conversation Cloud, insurers can prepopulate forms to personalize interactions and boost case manager productivity while also keeping claimant recovery on track. Additional capabilities include:

Harness the power of smarter automation to improve communications, maintain compliance and enhance the claims experience.
Integrate with core claims management systems such as Guidewire ClaimCenter, Duck Creek Claims and Sapiens ClaimsPro, enabling elements of straight-through processing and improving the user experiences for case managers.
Infuse intelligence into every step, from sentiment detection to built-in compliance, for SMARTER engagement from start to finish.

Digitizing the Workers’ Compensation Claims Experience Starts Now

Workers’ compensation claims can have a widespread impact—on the individual employee, the employer’s business and even the wider economy. Adopting a digital-first approach and replacing one-way interactions with intelligent, two-way conversations helps workers’ compensation insurers increase case manager productivity, reduce costs and deliver a modern experience that everyone involved will appreciate.

Expediting resolution and infusing ease and efficiency into every step of the claims management process improves outcomes for all involved parties, while also:

Streamlining work and managing costs for the insurer.
Supporting faster recovery for the injured worker, resulting in less emotional and financial stress and better life outcomes.
Mitigating productivity and future losses for the employer.

It’s time to digitize the workers’ compensation claims experience with a modern solution and a conversation-based approach.

—

To find out how the Smart Communications Conversation Cloud can help your business drive better workers’ compensation claims outcomes, contact us today.

Or, check out some additional resources about digitizing the workers’ compensation claims experience:

Modernizing the Workers’ Compensation Claims Process
The Workers’ Compensation Case Manager of Tomorrow
Reimagining the Workers’ Compensation Process for Today’s Digital World
Driving Better Outcomes for Workers’ Compensation (coming soon!)

Digital Transformation in Healthcare Claims

Posted on December 2, 2021 by Mary Featherstone

By: John Zimmerer, VP Healthcare Marketing at Smart Communications

Digital transformation in healthcare had been moving at a steady but very slow pace for years – until the pandemic forced the industry to accelerate its digital-first initiatives. Despite the progress made in the last 18 months, the healthcare industry still has plenty of opportunity to enhance the customer experience through more digital interactions.

One critical customer journey where this is particularly evident is claims. From finding, figuring out, filling out and submitting a claim form (e.g., for an out-of-network service); to receiving an adjudication notice, navigating to and reviewing an Explanation of Benefits (EOB); to having to contact the payer to ask a question about the claim and submitting an appeal, the whole process can often feel disjointed and inefficient.

In this post, we dive into the future of digital transformation in healthcare and how payers can reimagine the claims experience.

The Current State of the Claims Journey

Often, claims are considered a cost of doing business for health insurers. As a key component of the Medical Loss Ratio (MLR), an insurer’s primary objective is usually to minimize the administration and operational expenses related to processing claims and handling appeals and grievances.

Many claim-related communications are designed from the inside out, with regulations and risk in mind rather than with an eye toward the customer experience. Once the templates are created, they tend not to be revised much unless required by rule or due to an acquisition. These communications are treated as individual point solutions managed by IT, rather than as touchpoints that connect a customer journey.

Here’s a summary of today’s typical claim-related experience:

The member, Grace, receives an email notifying her that “a claim was recently processed.” Grace wonders which claim the email is referencing.
The email directs Grace to log into her payer’s member portal to review the claim. Grace looks for a link in the email to click but doesn’t see one. She opens a browser, logs in to her payer’s member portal, and navigates to claims.
Grace deduces which claim the email was referring to. She didn’t see a visual indicator, like a “new” tag or other label, so she assumes she’s looking for the most recent claim.
Grace clicks on the claim line item to view summary information, then on the EOB to see details. The EOB is a PDF file, originally designed to be printed and mailed, not for viewing on a computer screen or a mobile device.
Grace has a question about the claim. The EOB directs her (and every other member) to call her plan’s member services department. Grace would have preferred a self-service option.
Grace tells the member services rep that takes her call that she is certain that she had already satisfied her deductible prior to the date of service in question and feels that her responsible portion should be much lower. The call center rep points Grace to a form to request a redetermination (i.e., to file an appeal) and asks Grace if there’s anything else the rep can help Grace with.
A bit frustrated that her issue hasn’t been resolved to her satisfaction, Grace says, “no,” and hangs up the phone. She starts looking for the form the rep mentioned and wonders how she’ll know the payer has received it or how long it will take before her payer begins the redetermination process.

This interaction just increased the risk that Grace will not renew her plan (i.e., churn), but her payer doesn’t know that yet.

The Desired Future State of the Claims Journey

Fortunately, there is a better way that is relatively simple to implement and will deliver immediate value. A new, orchestrated process can connect these disjointed touchpoints into a guided experience and increase member satisfaction (and NPS scores). This future state can also lower claims administration expenses, especially for individual and group plans where these costs tend to be highest.

Here’s a revised version of the scenario above:

Grace sees a new link in the EOB to ask a question. The virtual agent senses the context of the question and pulls in information related to the specific claim.
After answering a few questions, the agent prepares, and Grace reviews and submits, a request for an organizational redetermination (i.e., a Level 1 appeal). All the information required for the appeal is prepopulated which means Grace clicks more than she types.
The request creates a case for the Appeals and Grievances (AG) group to review the claim. The case includes the appeal form with the information Grace provided.
The AG employee reviews the case and creates a determination letter from within her CRM. In this case, the request is approved; however, the editing software is flexible and allows the AG employee to create different correspondence if the request is approved, denied or pending (e.g., if additional information is required).
Upon generating the correspondence, Grace is sent an email with the determination letter attached and an NPS survey in the body of the email.
The entire history of engagements and all related activity – sends, opens, clicks, etc. – is available to any payer employee authorized to access Grace’s CRM record.

This future-state scenario is achievable with The Conversation Cloud^TM from Smart Communications, including these solutions for connecting the claims experience:

SmartCOMM^TM for sending the notification, EOB and correspondence
SmartIQ^TM for the internal appeal request, consent form and NPS survey
Orchestration across all the touchpoints and channels
Integrations, e.g., with Facets for claims data and Salesforce for case management

Accelerate Digital Transformation in Healthcare Claims

Smart Communications has helped accelerate digital transformation in healthcare claims for insurers like Blue Shield of California through its ISO-certified and HIPAA-compliant Conversation Cloud platform.

Ready to enable new members to self serve and streamline claims processes to improve member experience and reduce administration costs? Watch how our solutions help organiations like yours make connected claims experiences possible.

Taking a Proactive Approach to Risk Management in Insurance

Posted on October 5, 2021 by SmartComm

By: Ruth Fisk, VP of Insurance Marketing at Smart Communications

Insurance exists to protect us – as individuals, as families and as businesses – and assist us when we need it most, after natural disasters, accidents, illness and more. When it comes to risk management in insurance however, the industry is at an inflection point. Today, insurers need to take a more proactive approach to risk prevention.

A convergence of several macro-level trends is forcing insurers to rethink how they manage risk and engage with customers. Those trends include:

Increasing customer expectations for personalized, real-time interactions
Growing access to data and sophisticated technology
Rising competition from up-and-coming insurtechs

For decades, insurers have used a reactive approach to business. If an event occurs, a customer will initiate a claim and the insurer will respond appropriately. Today however, insurance companies must evolve to become more proactive and minimize risks as much as possible.

In this post, we dive into why a more proactive approach is beneficial to risk management in insurance, how modern technology and new coverage models can be beneficial and why optimizing customer communications is integral to success.

Sharing Education Opportunities

A proactive approach to risk management in insurance begins with education. In the midst of hurricane season, for example, customers need to be better prepared from an insurance perspective. There are some customers that have probably been insured for decades but have never filed a claim. If insurers are providing helpful emergency preparedness advice up front, it ultimately creates a better experience for customers if they know what to do before disaster strikes.

We have also seen an increasing number of insurers sharing advice guides, which aim to steer customers to the kind of coverage they should have, their greatest areas of risk and more. Whether it’s preparing for storm season or advice for a young adult just starting out, there are countless areas where insurance companies can provide more education, such as:

How to protect property from further damage
Tips for preventing housefires
How to prepare a disaster plan
How to file a claim
Benefits of a connected home
Wellness tips, including nutrition, exercise and stress reduction

New Use-based Coverage Models

Many up-and-coming insurtechs are moving to newer service models that provide coverage on a need-only basis – think a “pay as you go” model. For example, Trov offers digital, in-app embedded insurance products while Slice provides usage-based insurance products anytime and anywhere.

By adopting new coverage models, insurers can meet customers where they are. With telematics, Artificial Intelligence (AI) and more, insurers not only reduce risk, but also enhance the overall customer experience. The industry has already started adopting some of these practices with programs like safe driving apps that leverage telematics and data to help drivers secure better rates. And with homes becoming “smarter,” insurers need to take advantage of the data and insights newer technologies provide. Hippo, for example, offers monitoring systems that protect against fire, water damage and theft.

A New Era of Customer Conversations

Today, anything consumers want is only a few taps or clicks away. And with the pandemic forcing many people to rely solely on digital to meet even basic needs, customers have higher expectations than ever.

Insurers are increasingly being measured by how well they know their customers – experiences must be tailored to the individual. Successful personalization efforts depend on great data – collecting it in a way that is frictionless for the customer, and then leveraging a robust customer communications platform that can put it to use. Moving to a cloud model and leveraging open APIs will support a more modern and proactive approach to risk management in insurance. This will allow data from core systems, third-party solutions and more to be incorporated into tailored, personalized customer conversations.

Ultimately, customers want to feel like a name, not a number. Insurers that provide customers with risk mitigation tips and strategies, plus tailored advice to prevent (and what to do in the event of) an accident or natural disaster, will be the ones to come out on top of the competition.

—

Smart Communications is thrilled to be a Platinum Sponsor of Guidewire Connections 2021. Please stop by our booth (P2 in the Partner Pavilion Pinyon Ballroom) to chat with us and learn more about how we empower insurers to deliver more personalized customer conversations.

You can also catch us at our speaking session:

Mountain West Enriching Policyholder Experiences with Digital-First Strategies

Wednesday, Nov. 3, 2021

3:45pm – 4:30pm PST

Ironwood 1-2

If you’d like to schedule a one-on-one meeting with one of our representatives, please contact us today.

How Insurance Companies Can Thrive in the New Normal

Posted on May 20, 2020 by Ayla

By: Larry Hogan, Account Executive at Smart Communications

So far in 2020, insurers have had to find unique ways to quickly respond and adapt to a unprecedented level of disruption. The good news is, depending on the approach, 2020 also brought an unexpected opportunity for insurers to be champions for digital change – setting an example for how digital transformation should be embraced when we settle into a new normal.

Here are a few common challenges facing insurance companies today, and how adopting a digital-first approach to communications will help insurers become more resilient.

Claims Volume Fluctuations
Depending on the area of insurance that you’re in, claims volumes have likely either significantly increased or decreased in recent months. For P&C insurers, as more people are required to work from home and vacation plans have been altered, the number of traffic accidents are dropping. Fewer accidents means fewer claims. While some P&C insurance carriers have made some progress toward digital transformation, when it comes to automation, much of the industry is still heavily reliant on manual processing and in-person interactions. The good news is, reduced claims volume provides an opportunity for P&C insurers to find new ways to connect with customers. Consumer Federation of America recently reported that 80 percent of American auto insurers have announced that they will refund or credit drivers more than $6.5 billion over the next two months. Touchpoints like this are great opportunities to keep customers engaged and loyal – so it’s important that your business is digitally equipped to deliver these types of communications quickly and efficiently.

On the contrary, health insurance companies have seen a significant increase in claims that need to be processed quickly. Life insurance companies have also experienced an increased demand for policy applications and new account openings. Fabric, a provider of instant online life insurance says it has seen a 50 percent increase in life insurance applications since mid-February. Similarly, LifeQuotes, a national online life insurance agency, reports a 29 percent increase in applications requested since January 20. One way to adjust for a volume overload is to leverage a modern claims automation solution, which provides faster cycle times, increases employee productivity and ultimately yields higher customer satisfaction.

In both cases, either an increase in claims submissions or a decrease in claims submissions, insurers have been reminded of the importance of being a trusted resource to their customers all the time. It’s crucial to process claims quickly and effectively, but it’s also just as critical to the long-term relationship to maintain open lines of communications in between key milestones as well.

Call Center Overload
During a time of uncertainty, it’s easy to understand why customers would have more questions that usual and might want to seek out customer service representatives for assurance. Many insurance companies are seeing surges in operational volume with new claims being filed, general coverage and billing questions, and response to government mandated actions or new programs – the list goes on. As a result, insurance companies have experienced a spike in call center volume as individuals seek out immediate responses. If customers can’t reach you by phone due to high volumes and can no longer participate in the insurance processes that rely on face-to-face or paper-based transactions, you run the risk of losing the trust and personal touch that keeps customers loyal.

To ensure a consistent level of service during peak times, insurers have no choice but to rely on digital channels to communicate with their policyholders. With reduced mail and print processing and the delays that physical communications can be subject to, there’s a significant need to be able to process applications and correspondence faster. These challenges have forced those who lag behind in digital to catch up. According to VentureBeat, some companies are positioning AI as a solution to service gaps. While the use of AI and automation has been top-of-mind for many forward-thinking companies, most insurance companies still lack the digital tools and platforms needed to meet today’s on-demand customer expectations. Insurers should use this time as an opportunity to explore automated solutions, like chatbots, self-service portals, and mobile apps, which provide new communication channels that enable policyholders to engage in two-way conversations. These types of digital-first communication methods lead to smarter conversations and more consistent interactions throughout the entire customer lifecycle.

Finding the Solution Through Digital-first Communications
As customers become used to digital interactions as the new norm, there will be a changing level of expectation in how they are communicated with from now on. Life will not go back to normal – there will be a new level of expectation around digital-first communications. This is actually some much-needed good news. The changes made now will last long into the future– providing customers the digital-first experience they’ve been desiring can be achieved by embracing a modern cloud-based solution.

Are you ready to engage in SMARTER digital conversations with your customers? Connect with us today and we’ll show you how we can help.

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Forms Automation Can Enhance Enterprise Customer Communications

Purpose-Built for Today’s Enterprise Needs

Get in touch today to find out how SmartIQ enables enterprises to improve forms-based processes and empower interactive, two-way conversations.

1. Use Pure-Cloud Solutions to Power Core Operations

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3. Prepare to Remain Agile

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Visit the main Guidewire Connections 2022 page to learn more about the event or to get registered to join us in Las Vegas from October 23-26.

Provide the Ultimate Healthcare Customer Experience: The Guide to Member Engagement Strategies

Changing Customer Expectations and Regulations Drive Trends in Healthcare

Customer Experience Trends in Healthcare

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The Impact of Forms Automation on the Healthcare Customer Experience

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Introduction: Digitizing the Workers’ Compensation Claims Experience

Stage 1: Reporting the Injury

Stage 2: Investigating the Claim

Stage 3: Medical Management

Stage 4: Case Management

Stage 5: Settlement

The Conversation CloudTM: Designed to Drive Better Outcomes

Digitizing the Workers’ Compensation Claims Experience Starts Now

The Current State of the Claims Journey

The Desired Future State of the Claims Journey

Accelerate Digital Transformation in Healthcare Claims

The Conversation Cloud^TM for Health Insurers

The Conversation Cloud^TM: Designed to Drive Better Outcomes