A leading health insurance provider sought to streamline enrollment for their new commercial product for SMBs. Initially, they used two channels for enrollments: brokers and individuals with Salesforce CRM accounts. The client wanted to extend this feature to its commercial product as well and add another channel for enrollment – a private exchange vendor via EDI 834 files (a standardized electronic enrollment and billing document). Since Virtusa played a pivotal role in implementing the client’s existing enrolment process through the public exchange, Healthfirst partnered with Virtusa to implement an enrollment solution across all channels for its commercial product.
The client offers insurance plans to individual customers across various LoBs including Exchange (QHP) and Essential Plan (EP). As part of their expansion plans in the commercial space, introduced health plans for individuals and SMBs. By 2017, to make it easy for SMBs to buy their products, the client decided to add a Private Exchanges channel for enrolment of SMBs. They sought a partner who could help execute this vision flawlessly.
The solution needed to have robust error handling and operational views to ensure no applications were lost in transit. Virtusa built a solution that helped the client achieve these objectives as well as capture enrolment applications from the front end (Salesforce or EDI 834). The solution allowed enrolment operations personnel to review and confirm prior to getting the data in the membership systems.
Client was able to achieve significant business efficacies and was able to extend its enrolment options across SMBs and customers, driving seamless experience for users.