5 Ways to Transform the Healthcare Member Experience

Health plan member expectations are changing, and members demand more. They want better communication from their health insurance payer, timely answers to their questions, and seamless engagement through digital channels. Members are consumers whose service expectations have been dramatically shifted by the likes of Amazon, Netflix and Amazon.  Gone are the days of expecting members to communicate through snail mail or endure long hold times on the phone. Members expect options and self-service, and health plans can exceed those expectations with the digital customer engagement solution.

We’re all growing accustomed to an effortless and omnichannel user experience that we control. Texting has replaced phone conversations for all ages because it’s an easier and faster way to communicate. Our phones ping throughout the day reminding us of our upcoming deliveries, from the moment items are ordered to the moment they arrive on our doorsteps. There’s no denying we are in the digital age, and there is no turning back. Consumers expect access to information instantly, and there’s no better time to offer this than when delivering critical information to help members manage their health.

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Change often comes with a myriad of challenges, especially in healthcare. But it doesn’t have to be that way. There are simple automation solutions that health plans can implement to quickly and effectively enhance relationships with members. Not only do these solutions improve customer satisfaction, but they also streamline a health plan’s overall business. Offering 2-way digital communication leads to reduction in costs and increases in operational efficiency.

Here are 5 ways health insurance payers can automate customer interactions to improve member relations, their bottom line along with their employee engagement.

1. Coordination of Benefits

Coordination of Benefits is an aggravating process for everyone involved. It’s difficult for payers to keep track of the ever-changing secondary eligibility of all members and it’s time consuming to uncover other responsible parties. Plus, it consumes a lot of resources to track down that responsible party, and it’s even more costly if a health plan has to recoup payments.

On the other hand, members get frustrated when asked to fill out and return printed forms. They are focused on their health, don’t understand why they have to provide more details, and are expecting something easier and faster than antiquated snail mail communication.

An integrated intelligent automation solution can maximize cost savings and speed by digitizing the Coordination of Benefits process. Ushur’s secure conversational AI platform automates the communication through personalized texts or emails to members. The technology can quickly discover critical health plan information, verify additional responsible parties, extract data from photos of member I.D. cards, and seamlessly update member eligibility details within the health plan’s core systems.

2. Prior Authorization Communication

Obtaining prior authorization is an essential component of the healthcare process, yet it’s also one of the most frustrating. Member services representatives are inundated by high volumes of inbound calls. Members may have previously been unaware of prior authorization, and then feel blindsided while their treatment remains on hold until approved.  Then they are discouraged because they lack timely information about the status of the prior authorization request. They want information and they want it now.

Payers can reduce costs while proactively keeping members informed by implementing a conversational AI solution. Ushur’s platform helps streamline the entire process, allowing members to use their preferred digital channel, whether it’s SMS or email, to easily and securely communicate with their health plan. Ushur’s machine learning engine understands what members want, including the intent and context of healthcare terminology, and it easily integrates with payers’ existing systems.

The platform enables health plans to automatically notify members of a new prior authorization request received on their behalf.  And then Ushur can update members on the progress and outcome of their prior authorization, be it approved, rejected or denied.  This will reduce the number of inbound calls and create member service representative capacity. Appreciating sometimes members prefer to speak with a person, Ushur’s platform can offer members the option to schedule a call with a service representative. Better yet, members can continue interacting with Ushur’s technology to find a doctor, schedule appointments or ask additional health insurance questions.

3. Appointment Reminders

When members miss their appointments, it hurts everyone. Members experience delays in care and potentially compounding comorbidities. These health complications equate to more costly care.

Payers can improve member engagement with the adoption of technology. Ushur’s conversational AI platform enhances the overall member experience by automating the entire appointment process. Members receive digital appointment reminders via text or email, and can continue interacting with their health plan to receive reminders and reschedule appointments. Ushur’s solution integrates with existing Customer Relationship Management Systems and Electronic Health Record (EHR) systems through a secure, no-code application This enhances a health plan’s relationship with members by simplifying the communication process and coordination of care along the healthcare journey.

4. Member Medication Adherence


There are many reasons in which members may not take their medication as prescribed. Some may not be able to afford the medicine. Others may struggle to follow complex dosing schedules. Some may even forget to refill their medication altogether. Regardless of the reason, health insurers are losing money and members’ well-being can be compromised.

Ushur’s secure conversational AI platform can improve this process, helping members stick to their medication regimen through automated communication. Members can receive real-time information via a text or email to their phone, tablet or computer for refill reminders and to request refills. Plus, members can use this same preferred method of communication to inquire about side effects and schedule a call to ask follow-up questions about their medication.

5. Appeals and Grievance Processes

Payers get bogged down in the appeals and grievance process. From adhering to regulatory requirements to relying on manual workflows, the entire process can be costly. Often, payers are slow to communicate with members, leaving them frustrated and wanting more out of the experience.

Ushur’s conversational AI capabilities and SmartMail intelligent email automation can help by eliminating time-consuming interactions and centralizing important data in a single, secure and user-friendly platform. With the power of machine learning, the technology understands the intent and context of healthcare terminology and quickly scans emails and attached documents to capture necessary member information. Ushur accurately categorizes member inquiries and automates email responses, making the entire appeals and grievance process smoother. Members receive real-time status updates through SMS or email, reducing the inefficient back-and-forth process between a health plan and their members.

When members want information that impacts their healthcare, they’re frustrated if they’re forced to use slow processes dependent on legacy systems. That’s where automation comes in, and it benefits both a health plan’s members and their operating costs in substantial ways. Transformation doesn’t have to be scary. Implementing digital solutions is easier than ever and is becoming more critical due to consumer demands. These solutions improve a company’s bottom line, enhance their relationship with their members, and will give health plans a competitive edge by supporting their members throughout their healthcare journey.

Now is the Time to See How Ushur Can Transform Your Customer Experience

Do you know that a customer has a 99% chance of trusting an insurer that makes them feel well informed? From quote to policy to billing to claims – for P&C, Life, Accident or Healthcare, automate every insurance use case and turn every single customer, member, claimant, agent and broker interaction into a transformative experience.

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About Ushur

Ushur delivers the world’s first AI-powered Customer Experience Automation™ platform that has been purpose-built, from the ground up, to intelligently automate entire customer journeys, end to end. Designed to deliver delightful, hyper-personalized customer experiences through rapid issue resolution and unified, omnichannel engagement, Ushur is the first-of-its-kind system of intelligence. It combines Conversational Automation and Knowledge Work Automation in a No-Code, Cloud-native, SaaS platform to digitally transform every step of the complete enterprise customer experience – from Micro-engagements™ to entire customer journeys.

Backed by leading investors including Third Point Ventures, 8VC, Pentland Ventures, Aflac Ventures and Iron Pillar, Ushur’s Customer Experience Automation™ solutions are currently in production at some of the leading insurance providers across the globe including Irish Life, Unum, Aetna, Cigna and Tower Insurance.

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