The Value of an Automated Customer Experience for TPAs

automated customer experience

The Healthcare Industry is Moving — Don’t Be the One Falling Behind

The healthcare industry as a whole is moving faster and doing more than ever before. Much has been spurred on by regulation, whereas shifts in other areas can be attributed to the meteoric increase in the number of new technology solutions available for healthcare providers as well as those seeking care. And while utilization hasn’t grown, what has grown is spending.

When more money is being spent on healthcare, despite there not being a noticeable increase in utilization, there is naturally more obligation and pressure to support that spend. A significant portion of this responsibility falls on the shoulders of TPAs, who must substantiate claims in order for plan participants to be reimbursed.

But how can TPAs keep up with the increasing pressures of higher spending? How can you make your operations more efficient to reduce the administrative burdens of EOB processing on your team? How can you better bridge the gap between your benefits administration platform and your customers’ insurance carrier? How can you maintain satisfactory results for plan participants, employers, and brokers that connected you with the opportunity to support them?

An Automated Customer Experience is Your Key to Success

As the U.S. population continues to age, as companies grow and add more participants to their sponsored health plans, and as brokers establish new relationships and bring you into the picture, your responsibilities are only going to increase. While you may have an amazing, well-trained team, people only have so many hours during the course of a day. And far too many TPAs are still relying on outdated and inefficient processes and systems to get work done.

Automation is the answer, but you must carefully consider how it will impact the customer experience. Just about anything in your workflow can be automated, but if the plan participant has no clue what they’re doing, what you’re asking, and why it’s important, it will all be for nothing. Let’s explore a few ways in which having an automated customer experience can make or break your success as a TPA in an increasingly complex time for healthcare.

1. Convenience

Convenience plays an important part in your overall success. TPA customer convenience is a tried-and-true component of any customer experience strategy, but there’s more to it. Yes, you need to make your plan participants’ experience as easy and smooth as possible. This ensures you get the data you need to substantiate their claim, but it also makes employers’ lives easier as their HR departments no longer have to answer an influx of questions about what’s going on, how to get information, and what to do with it when they have it.

Convenience is also critical to your role in providing an automated customer experience. Automation isn’t just a customer-facing benefit. It’s clearly a solution for your team as well. By automating as much as possible, your team will be able to offload lower priority, less technical, or simply less important tasks, enabling them to spend time on more valuable initiatives. 

An automated solution such as a BenAdmin integration will also make harvesting the data you need significantly faster, increase its accuracy, more efficiently route it throughout your organization, and ultimately help your team get work done correctly — the first time.

2. Speed

Beyond customer and TPA convenience, there’s another reason automation makes sense: it works faster than people do. Plain and simple. Plan participants don’t want to sit around waiting to find out what’s going to happen with their claim — they want to be reimbursed. On your end, you don’t want to be sitting around after substantiating a claim wondering when you’ll be paid for your role in the process.

An automated solution will help make your claims processing speed faster, get you access to important data right away, and of course, enable measurement so you can more accurately provide employers and brokers with reporting on your success. Why bog down your team (and customers) with slow, burdensome tasks when they can be done automatically — faster than ever before? This will go a long way in creating a successful automated customer experience.

3. Self-Service

While an automated integration platform will save your team significant time internally, even greater value can (ideally, must) be realized through claims self-service. The success of an automated customer experience relies on plan participants being able to not only provide the information you need in a way that’s easier for them but also in a way that completely takes it off your plate.

For TPAs, the process of EOB harvesting and substantiation starts with an email or call to the participant to obtain the EOB. The participant has to find it (if they even know what it is) and either scan and email or fax it to the TPA. While that’s happening, TPAs are essentially left waiting until the information needed is received. And during crunch times such as year-end, that’s a recipe for disaster. 

Using an automated integration platform like TPA Stream, TPAs can send helpful instructions to participants directly (white-labeled as the employer), allowing them to sign in to the insurance carrier portal of choice and allow TPA Stream to immediately scan for and harvest EOBs. Once the connection is made, the process is completely automated from that point forward. No more emails, calls, or faxes. Just the data that TPAs need, right when they need it.

Build a First-Class Automated Customer Experience with TPA Stream

TPA Stream has built one the most integrable, advanced solutions for improving TPA’s workflow and strengthening relationships with plan participants, employers, and brokers. Our platform integrates with multiple benefits administration platforms and features numerous carrier options, ensuring that you’re able to provide your customers with the convenience, speed, and self-service they — and you as their TPA — need for a positive experience.

Get in touch with us today to get a private demo of the platform.

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