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Becoming a Digital Payer: Advancing Customer Service

HealthEdge has identified five key attributes that drive digital payers, enabling them to rise above the competition and lead the way to better outcomes across the entire healthcare delivery system.

Digital Health Payers focus on:

  1. Improving end-user and member centricity
  2. Achieving higher levels of quality
  3. Increasing transparency
  4. Advancing customer service
  5. Reducing transaction costs

Over the next few weeks, we will dive deeper into each attribute, delivering resources, information, and insights to enable health plans to transform into digital health payers. As we continue the conversation around what it means to be a digital payer, this discussion focuses on advancing customer service.

Ever-Increasing Customer Service Levels

In a service-oriented economy, the organizations that deliver the best service typically win – and healthcare is no different. Health plans that are not able to optimize customer service are not only frustrating their members and providers, but they are also missing out on significant efficiency gains and cost savings.

The recent study, The State of the Healthcare Consumer, conducted by Porter Research, found that 25% of respondents required two or more calls to achieve a resolution when contacting their health plan for support. The study also indicated that health plans waste more than $654.5M per year in unnecessary claims resolution calls.

Digital payers focus on resolving these challenges by leveraging technology to deliver consistent, high-quality customer service. By using next-generation, digital solutions, health plans can better equip customer service teams to support inquiries, automate processes to speed service, and advance personalization.

Support Inquiries from Members, Providers, and Other Stakeholders

Digital payers empower customer service teams with access to real-time, accurate information to support inquiries from members, providers, and other stakeholders. Providing immediate answers to those seeking benefits information, cost estimates, and claims status improves member engagement, satisfaction, and financial clarity. Payers that embrace digital transformation use next-generation tools and connectivity to ensure customer service teams have the information they need when they need it.

Automating Processes to Expedite Service

Reducing costs and improving operational efficiencies are today’s top priorities, accounting to the 2022 Annual Health Insurance Market Report of more than 300 health plan executives [link to exec survey summary].

To help manage costs and identify new efficiencies, digital payers turn to modern technology to automate repetitive business processes that can improve customer service. By making critical information more readily available to support inquiries and self-service activities, customer service representatives are able to focus their time on more complex inquires requiring high-touch, one-on-one engagement. In addition, customer service representatives can respond faster and with more accurate information to member inquiries.

Advancing Personalization

Consumer have grown to expect a personalized experience because of their regular interactions with retailers and digital giants. Digital payers have the data, information, and tools to deliver a personalized experience from their members. With next-generation solutions, digital payers have greater access to more real-time member data that allows them to personalize their communications with members, further improving member satisfaction and loyalty.

Increasing Service Levels as a Digital Payer

HealthEdge provides the digital foundation to enable digital payers to improve processes for handling member inquiries, automate and speed workflows, as well as add the personalization that today’s healthcare consumer has come to expect. Next-generation solutions from HealthEdge deliver a connective transformation that improves the flow of accurate, up-to-date information. As a result, digital payers can use that information to align communications, improve access to data, and continually elevate levels of service.

To learn more about how your health plan can leverage modern solutions from HealthEdge to improve customer service and become a digital payer, visit or email [email protected]