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Behind the Scenes: HealthEdge® Customer Operations Team

With hundreds of health plans depending on HealthEdge’s HealthRules® Payer core administrative processing system (CAPS) every day, members of the Customer Operations team have their work cut out for them.

How HealthEdge Customer Operations Team Supports Health Plans

This team is comprised of four different groups that work cohesively together to ensure customers have the best possible experience:

  1. The infrastructure operations team ensures the company’s private cloud, networks, and operational spaces are secure and available.
  2. The technical support services team manages the response to all inbound customer product inquiries and support tickets by coordinating with customers and product team members to facilitate fast responses and resolutions to any issues that may arise.
  3. The customer success management team is ultimately responsible for understanding the current and future needs of HealthRules Payer customers and prioritizing the work for the rest of the organization. They are the customer “captains” who understand each customer end-to-end from an operations perspective.
  4. The business intelligence team works with the data to enable the rest of the team and customers to gain actionable insights so they can proactively address opportunities for improvement.

Although much of this work sounds technical, the “north star” for this group of hard-working, seasoned professionals is all about helping HealthEdge customers give their members access to the healthcare benefits and services they need when they need them.

The internal tagline of being “Customer Obsessed” is ever-present among all team members who constantly strive to learn more about their customers’ business to provide a more personalized experience.

Equally important is the team leaders’ focus on humanizing the healthcare technology experience for employees. The work is more than just solving a technical problem. It’s about making sure that the eligibility file goes through correctly so that the mother gets access to the medications her sick child needs or the grandmother can get the medical procedure she needs to experience the joys of playing with her grandchild.

These scenarios remind the HealthRules Payer customer operations team members of their purpose: to always do what is best and suitable for their customers so their customers, in turn, can do what is best and ideal for their members.

The Future is Bright

As the HealthEdge customer community continues to expand, the customer operations leadership team is also looking to improve the lives and experiences of their employees. By establishing more standardized processes and proactively addressing the demand for unplanned work items, they are giving employees more time to focus on discovering innovative ways to support the growing customer base – all for the betterment of HealthEdge customers.

In addition, the team is working toward more standardized processes and a more integrated experience for customers of multiple HealthEdge solutions, including GuidingCare® for care management, Source for payment integrity, and Wellframe® for digital member engagement. As more integration points across these solutions become available, customers will have a more seamless experience working with HealthEdge.

Finally, as the organization encourages and enables health plans to become digital payers, HealthEdge is adopting more digital-centric capabilities that automate repetitive, manual tasks and improve productivity. Modern technologies that proactively monitor and adjust server capacity are also being implemented to benefit team members and customers alike.

The HealthEdge Customer Operations team is more than just a group of engineers and technical resources who support clients. They are members of a dedicated group focused on making a difference in people’s lives by enabling high-quality healthcare at the right time and the right place.

To learn more about the HealthEdge customer experience, visit