HealthRules® Payer Behind the Scenes: How HealthEdge® Customer Operations Empowers Payers
Discover how the HealthEdge® Customer Operations team makes it easier for HealthRules® Payer customers to meet their business goals.
Health plans across the U.S. depend on the HealthEdge HealthRules® Payer solution every day for streamlined and integrated core administrative processing. The HealthEdge Customer Operations team is focused on ensuring the platform runs as seamlessly as possible, so our customers can worry less about accessing the tools they need and spend more time serving their members.
How the HealthEdge Customer Operations Team Supports Health Plans
Internally, HealthEdge teams make a commitment to being “customer obsessed,” and team members consistently strive to learn more about our customers—from the ways they work to their key operational goals—to provide a personalized experience.
As part of our commitment to customer excellence, our team leaders work to humanize the healthcare technology experience for our end users. We go beyond solving technical problems to make sure that key functions happen seamlessly—like eligibility files going through correctly so that a mother can get the medication for her sick child, or a 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 improve platform quality and access for our customers so their teams can do what is best for their members.
“Our team’s deep industry knowledge allowed us to make informed decisions with confidence, while HealthEdge experts guided us through configurations, troubleshooting, and ongoing refinements.”
-Chief of Staff to the CTO, Health Plan
Our 4-Prong Approach to Customer Operations
The Customer Operations team is comprised of four different groups that work cohesively together to ensure customers have the best possible experience:
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- The Infrastructure Operations team ensures the company’s private cloud, networks, and operational spaces are secure and available.
- 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.
- The Customer Success 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.
- The Business Intelligence team works with the data to allow 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.
“Overall, the migrations away from our legacy system to HealthRules Payer went very well. As with any large project, there is an initial learning and adjustment period, but the HealthEdge team of experts was with us every step of the way.”
-VP of Claims Operations, Health Plan
The Future of Customer Operations
As the HealthEdge customer community continues to expand, the Customer Operations leadership team is looking to improve our team’s own experiences. By establishing more standardized processes and proactively addressing the demand for unplanned work items, they are giving employees more time to discover 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 HealthEdge Source™ for payment integrity, HealthEdge® Provider Data Management for managing provider networks, GuidingCare® for care management, 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.
“I was extremely impressed with the HealthEdge team’s depth of knowledge and blown away with the ideas that they already had in preliminary meetings”
-Director, Eligibility and Operational Support, Shared Services Organization
Finally, as the organization encourages and enables health plans to become digital payers, HealthEdge is adopting more digital-centric capabilities that automate 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 optimizing your experience using HealthRules Payer, visit our data sheet: Optimization Assessment for HealthRules Payer Customers.
