Pivotal CRM for Healthcare Insurance
Creating stronger, more profitable relationships, one member
at a time
Key Benefits: Despite a relentless rise in premiums well beyond the rate of inflation
• Reduce paper touches in the last decade, the return for money spent on health plans is not
• Consolidate member data resulting in better service or better coverage for members. Healthcare
• Grow membership payers face unprecedented pressure to deliver new value that is defined
in terms of lowering medical costs, decreasing administrative waste,
• Improve broker loyalty
and improving the medical outcomes of the members they serve.
• Manage renewals for profitability
Inefficient, paper-based administrative processes threaten the future success of health plans.
• Automate underwriting
Healthcare payers that learn how to automate their paper-intensive processes and focus on
• Reduce enrollment administration member needs will gain market share and increase profits.
To learn more about Pivotal CRM healthcare Pivotal CRM offers award-winning customer relationship management (CRM) software designed
insurance solutions, please call specifically for healthcare insurance payers. Pivotal’s healthcare solutions enable payers to build
+1 877-PIVOTAL or e-mail: firstname.lastname@example.org. real healthcare value by building outstanding customer experiences. This is integral to creating
stronger, more profitable member relationships.
Designed Specifically for Healthcare Insurance
Pivotal CRM’s unique healthcare insurance solution is built from years of experience and from
working closely with healthcare insurance experts. Out of the box, Pivotal Healthcare Insurance
Suite delivers deep, industry-based functionality, providing a significant head start with as much as
75% - 90% of the features typically needed by healthcare payers.
Pivotal Healthcare Insurance Suite is a comprehensive front office solution that enables insurance
organizations to automate sales, marketing, underwriting, enrollment, and renewal of individual
and group health insurance plans. You’ll have the ability to serve and manage your brokers,
members and employer groups with unprecedented efficiency and effectiveness.
Comprised of Pivotal Healthcare FrontOffice, Pivotal Healthcare eBroker, and Pivotal Healthcare
eEnrollment, the suite delivers a scalable and sophisticated foundation for healthcare insurance
payers. Implement any product within Pivotal Healthcare Insurance Suite based on your business
needs, or deploy the entire suite as a comprehensive end-to-end solution.
Regardless of your size or complexity, Pivotal CRM healthcare solutions encompass all the
necessary components for successful member acquisition, retention, and growth. These
processes include effective:
• Lead Management • Rating/Underwriting
• New Business Quoting • Online Enrollment
• Renewal Processing • Back Office Integration
Pivotal Healthcare FrontOfficeTM
Streamline processes and gain a holistic view of your most valuable information
Pivotal Healthcare FrontOffice is an intelligent employee facing, browser-based, front office
automation and workflow application. It links sales, marketing, underwriting and renewal operations
together into a single, consolidated view of your entire book of business. As the “centerpiece” of the
Pivotal Healthcare Insurance Suite, employees are provided with information and automation tools
needed to manage key relationships. As a result, healthcare insurance companies can acquire,
retain and grow memberships more effectively, reduce operating expenses, and increase revenues.
Pivotal CRM | Datasheet
Pivotal Healthcare FrontOffice enables your company to:
• Gain better pipeline visibility. Proactively generate sales leads through a defined process that
pre-qualifies and distributes information to the appropriate sales person or broker, including
communication to and from underwriting, to assist the sales team in closing the sale.
Leverage Underwriting Automation
• Focus rating and underwriting efforts where you need it most. Choose which groups require
manual intervention and which groups can be handled through automation procedures.
• Eliminate re-keying of data by having an integrated rating and underwriting solution.
• Benefit from straight-through processing. Eliminate paper-based department-to department
hand-offs. Employees work smarter, together and faster.
Manage Renewals for Profitability
• Reduce the number of days it takes to produce renewals to just minutes. Leverage auto-renewal
processing that is integrated directly into the rating solution and managed through your renewal
• Link renewal processing to the rest of the organization in order to proactively plan for additional
workload during busy periods.
Improve Back Office Integration
• Reduce duplicate data entry and eliminate human error. Consolidate multiple data silos into one
enterprise wide database and integrate it all into other front and back office applications.
Pivotal Healthcare FrontOffice functionality highlights:
• Industry-specific data model • Data-driven business rules
• Multi-Carrier, Multi-Region support • Inter-departmental workflow
• Flexible plan library • Customer and prospect tracking
• Activity management • Automated renewals
• Rating and underwriting automation • Commission tracking
• Built-in integration framework
Regardless of your size or complexity, Pivotal Healthcare FrontOffice will:
• Drive sales, marketing, broker relations, underwriting and renewal operations in realtime, with
cross-enterprise communication and collaboration.
• Capture, deploy, and repeat organizational best business practices across the entire enterprise
with a holistic view of the most valuable information.
• Enhance decision making and planning with a complete “roll-up” summary to the group level.
Leverage this one-stop group snapshot across all product lines including: Profit/Loss To Date
and Membership Summary.
Pivotal Healthcare eBrokerTM
Build broker loyalty with powerful, online self-service
Pivotal Healthcare eBroker is the web-based, broker-facing component of the Pivotal Healthcare
Insurance Suite. It enables healthcare payers to significantly memberships and reduce
administrative overhead by providing brokers with automation tools in order to close deals with
ease and efficiency. The eBroker provides sophisticated broker management, allowing a “push” of
information organization to the broker, as apposed to a “pull” by the broker from your organization.
Set a standard of value and become the easiest and first choice by brokers.
Pivotal CRM | Datasheet
Pivotal Healthcare eBroker enables your company to:
Streamline New Business Quoting
• Increase response time. Empower brokers to produce their own new business quotes through
powerful self-service that is linked to your centralized quoting solution.
• Leverage integration to a real-time rating engine (where available) and integration to underwriting
for rate requests (where real-time rating is unavailable) to highlight payer accuracy and timeliness.
• Automate and simplify the sales process with efficient demographic entry and easy plan selection.
Automate Renewal Processing
• Deliver renewals to your broker community electronically instead of on paper application forms.
• Incorporate your brokers directly into the renewal workflow process.
• Allow brokers to add alternate plans and receive rates immediately without underwriting interaction.
Pivotal Healthcare eBroker functionality highlights:
• New business quoting • Census import and export
• Easy plan selection • Proposal production
• Renewal review and processing • Book of business management
• Activity management • Detailed reporting
eBroker provides significant cost savings and real productivity gains. Build your credibility as
a “best value” healthcare payer by:
• Managing broker relationships. Provide simple, zero-training, web-based, real time interaction
for brokers to increase loyalty and to highlight your efficiency and timeliness.
• Increasing a broker’s face time with customers and prospects by eliminating inefficient
and paperintensive processes. Ensure internal employees are redeployed to more
• Increasing membership and retention through a high level of responsiveness and accurate,
personalized sales and service even after business hours when human assistance is unavailable.
Pivotal Healthcare eEnrollmentTM
Reduce paper and streamline new business enrollment with intelligent self-service
Pivotal Healthcare eEnrollment enables your company to: Pivotal Healthcare eEnrollment reduces
both the time and effort required for brokers and group administrators to enroll new groups
and members by giving them online enrollment capabilities in lieu of paper forms. As the online
enrollment component of the Pivotal Healthcare Insurance Suite, this intuitive, external-facing
application guides brokers, group administrators and enrollees through the complete enrollment
process every step of the way.
Pivotal Healthcare eEnrollment enables your company to:
Accelerate New Business
• Eliminate the bottleneck in getting enrollment applications processed. Provide healthcare payers
with complete, step by step, wizard-driven, online enrollment capabilities, including questions
that are only relevant to each enrollee.
• Maintain flexibility in considering the reality of legacy paper processes with Pivotal CRM’s
support for “mixed mode” enrollment.
• Re-purpose time spent on data entry for increased time spent on sales activities including face
time, calls and communications.
Reduce Paper Touches
• Significantly reduce the number of times members, brokers, and staff need to touch paper
applications. Feed medical questionnaires directly into underwriting and eliminate another point
of redundant data entry.
Pivotal CRM | Datasheet
Pivotal Healthcare eEnrollment Clear the Underwriting Bottleneck
functionality highlights: • Improve data capture and eliminate incomplete or illegible applications. Online enrollment
• Simplifies the group installation process forms, featuring required fields that feed directly to underwriting, increase data accuracy and
• Supports separate process for each
• Adds or deletes questions based on previous
information eEnrollment provides the necessary tools to help you to:
• Never enter information more than once • Leverage data collecte during the quoting process.
• Wizard-style guided completion • Enable the capture of data, not paper.
• Data driven navigation and business rules • Feed medical questionnaires into the medical underwriting process and eliminate another point
of redundant data entry.
• Supports unlimited supplemental enrollment
forms • Populate existing state-filed enrollment PDF forms and eliminate the need to re-file.
• Can be integrated to imaging and OCR/OMR/ We will help you select, plan and implement the most effective Pivotal CRM healthcare insurance
IMR solutions solution, including the right technology and strategy. Choose any product within Pivotal Healthcare
• Supports batch upload from Insurance Suite based on your business needs, or deploy the entire suite as a comprehensive
Pivotal Healthcare Insurance Solutions
Key Processes Pivotal Healthcare Products
Lead Management – Gain better visibility into the pipeline. Pivotal MarketFirst,
Proactively generate and manage a variety of sales leads
Pivotal Healthcare FrontOffice
through a pre-defined process.
New Business Quoting – Empower customers or brokers to Pivotal Healthcare FrontOffice,
produce their own new business quotes through powerful
Pivotal Healthcare eBroker
Renewal Processing – Reduce number of days it takes to Pivotal Healthcare FrontOffice,
produce renewals to just minutes with auto-renewal processing
Pivotal Healthcare eBroker
that is integrated directly into the work flow.
Rating/Underwriting – Eliminate paper-based department- Pivotal Healthcare FrontOffice
to-department hand-off by leveraging rating and underwriting
automation and integration.
Online Enrollment – Enhance the enrollment experience Pivotal Healthcare FrontOffice,
for brokers, group administrators and enrollees through an
Pivotal Healthcare eEnrollment
efficient and easy to use online process.
Back Office Integration – Reduce duplicate data entry by Pivotal Healthcare FrontOfficePivotal
consolidating multiple data silos into one enterprise-wide
database and integrating it all into your back office.
Take the Pivotal Step with Pivotal CRM for Healthcare Insurance
To learn more about how Pivotal CRM can help healthcare enterprises create stronger, more profitable relationships, call us today at +1 877-PIVOTAL
(+1 877-748-6825) or visit us at http://www.pivotal.com.
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