Pivotal CRM Data Sheet-Software for Healthcare Insurance

							                                              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: info@pivotal.com.   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.

                                              Our Solution
                                              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:
Create Opportunities
• 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
  process workflow.
• 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

Key Benefits

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

Key Benefits

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
  value-added activities.
• 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
                                                           stakeholder satisfaction.
• Supports separate process for each
  enrollment form
                                                         Key Benefits
• 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
                                                         end-to-end solution.

                                                         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
                                                          self-service.
                                                          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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