Health Plan CRM

Improve Member Experience With Health Plan CRM

Why the Largest Health Plans Trust Inovaare's Health Plan CRM

Member experience has compliance designed into the core

Health plans must manage customer interactions with members, providers, vendors, regulators and other third-party companies. These interactions cross multiple areas including Member Services, Enrollment, Provider Services, Social Services, Case Management, and Appeals & Grievances.

Many interactions require multiple departments to participate in the issue-resolution process. In other situations, various departments require real-time visibility into a customer’s history and the ability to schedule future activities for them. Health plans need a platform to help ensure regulatory compliance and generate CMS-compliant reports, ideally at the touch of a button.

Inovaare’s  CRM solution exclusively focuses on the operational and regulatory needs of healthcare payers.

Regulatory Compliance Management software
Achieve perfect regulatory audits and elevate star ratings

Member Services

Since the CMS incentivizes health plans to improve the end-to-end member experience, its critical for payers to provide its members what they need, when they need it. Every touchpoint counts. So Inovaare designed its cloud-based Members Services module to help health plans eliminate audit findings. Health plans can now avoid Civil Monetary Penalties (CMPs) and Notices of Non-compliance (NONCs) on CMS call logs since the system ensures 100-percent accurate classification and processing of cases. As a result, payers will improve overall revenues and enhance member experiences, all of which leads to improved star ratings.

Help Healthcare providers avoid CMPs and NonCs

Provider Services

After the CMS established a value-based program to reward healthcare providers for the quality of care they provide Medicare members, providers need to ensure better care for individuals and better health for populations at lower costs in order to improve quality. So Inovaare designed its cloud-based Provider Services module to help healthcare providers eliminate audit findings. Health plans can now avoid Civil Monetary Penalties (CMPs) and Notices of Non-compliance (NONCs) on CMS call logs since the system ensures 100-percent accurate classification and processing of cases. As a result, payers will improve overall revenues through enhanced member experiences, all of which leads to improved star ratings.

Key Health Plan CRM Features

Health Plan CRM—powered by real-time omnichannel and end-to-end workflow automation—delivers improved member experiences through more efficient processes. This industry-specific CRM solution is designed to meet customer service needs by offering these key capabilities:

  • Integrated computer telephony integration (CTI): Personalized screen popups within the agent desktop
  • Real-time omnichannel: Consistent and personalized customer service experiences across phone, web, email, chat and Facebook
  • Smart guided interactions: Capability driven by “Best Steps” to optimize issue-resolution processes
  • One-click case resolution: ROI achieved immediately by eliminating manual, time-consuming processes and resolving them with a single click
  • Dynamic case management: 360-degree view of members by connecting people and processes for end-to-end issue resolution
  • Tasks: Collaboration achieved through Inovaare’s Intelligent Task Navigation
  • Contextual knowledge management: Knowledge sharing at the point of need—without a required search—reduces average handle time and drives quicker resolutions
  • Personalized landing page views by role: Configurable landing pages help optimize productivity
  • Built-in compliance: Reduced misclassification inquiries—achieved by identifying potential errors at the point of data entry—helps minimize audit risk
  • Dashboard and analytics: All work activities, urgent issues, high/low performers, compliance-related reports and configured KPIs displayed in intuitive dashboards to empower better decision making

Health Plan CRM Packages

Health Plan CRM Pro and Health Plan CRM Enterprise

Inovaare knows the world of Medicare, Medicaid and Commercial health plans from decades of hands-on Member Services department oversight. This expertise resulted in a software platform rich in features and it’s unparalleled in the market.

Inovaare created two health plan CRM packages to meet any health plan’s unique requirements: Health Plan CRM Pro 30 and Health Plan CRM Enterprise. For many health plans, Health Plan CRM 30 is an out-of-the-box solution that can be implemented within 30 days to lower operating costs and improve member experience. However, for payers who require more complex processes, Health Plan CRM Enterprise can be customized to address each requirement.

Health Plan CRM Pro 30

Quick implementation solution for health plans
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  • Real-time Omnichannel
  • Computer Telephony Integration (CTI)
  • Caller Authentication
  • Personalized Home Pages by Role
  • Multiple Case Creation
  • Smart Guided Interactions
  • One-click Case Resolutions
  • Dynamic Case Management
  • Contextual Knowledge Management
  • Task Management
  • Built-in Compliance
  • Logical Workflows
  • Banner Alerts
  • Dashboard & Analytics
  • Admin Portal
  • Member Data Integration
  • Provider Data Integration
  • CONFIGURABLE FEATURES
  • Roles
  • Categories
  • Tasks
  • Banner Alerts
  • Reports
  • Credentialing System Integration
  • Claims Data Integration
  • Provider Portal Integration
  • Fully Customized Solution
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Health Plan CRM Enterprise

Customized implementation solution for health plans
Request a Quote
  • Real-time Omnichannel
  • Computer Telephony Integration (CTI)
  • Caller Authentication
  • Personalized Home Pages by Role
  • Multiple Case Creation
  • Smart Guided Interactions
  • One-click Case Resolutions
  • Dynamic Case Management
  • Contextual Knowledge Management
  • Task Management
  • Built-in Compliance
  • Logical Workflows
  • Banner Alerts
  • Dashboard & Analytics
  • Admin Portal
  • Member Data Integration
  • Provider Data Integration
  • CONFIGURABLE FEATURES
  • Roles
  • Categories
  • Tasks
  • Banner Alerts
  • Reports
  • Credentialing System Integration
  • Claims Data Integration
  • Provider Portal Integration
  • Fully Customized Solution
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