CROSS INDUSTRY Award Winning Customer Service Solutions for Growth, Retention and Service Excellence

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1 CROSS INDUSTRY Award Winning Customer Service Solutions for Growth, Retention and Service Excellence

2 Customer Process Management: The Next Step Beyond CRM Healthcare organizations are increasingly looking to create market differentiation by providing exemplary customer service. Consumerism has made this task even harder. Members are taking a more active role in their healthcare choices and providers are more savvy about wielding their market power to impact member retention. To be competitive, healthcare organizations need to provide unparalleled service to all their customers across all interaction channels. Traditional customer relationship management (CRM) solutions focus on consolidating customer data, but rely on employees to understand the breadth of information and translate it into appropriate actions resulting in inconsistent and ineffi cient service. Transcending CRM, Pegasystems Customer Process Manager for Healthcare (CPM-HC) matches customer intentions with business goals at the moment of customer interaction for increased loyalty, productivity and growth. Built expressly for Healthcare Payers, CPM-HC delivers a rich framework of customer service processes that uses the power of rules-driven business process management (BPM) to intelligently integrate functions, essential enterprise data, and human tasks into effi cient and streamlined customer-centric processes. 1 BPM: Business Process Management. See for instance (Khoshafian, Millennial BPM, 2010).

3 Business Process Management: The Key to Service Excellence Experts agree that focusing and responding to customer needs through optimizing business processes is the only way for organizations to create differentiated customer service. According to the Gartner Group: The focus will continue to shift from internally oriented business operations to an emphasis on the experience and intent of customers. CSS will continue to focus on integration and workfl ow as opposed to search for a CRM suite. Forrester Research is even more prescriptive in declaring process management as necessary for service excellence: CRM is becoming customer process management. Process innovation is key to delivering a branded customer experience that will differentiate your company from competitors. Pegasystems: The Leader in Business Process Management Technology Pegasystems has been delivering award-winning business process management technology and customer service solutions for nearly twenty-five years was another award-winning year for Pegasystems, which earned leadership status from several different analysts in multiple categories. In the Business Process Management category now seen as a critical factor in customer service excellence Pegasystems earned top marks (see below). 1

4 Pegasystems: The Leader in Customer Service Management For the past several years, Pegasystems has been recognized for its contributions to customer service. Customer Interaction Solutions magazine ( named Pegasystems Customer Process Manager (CPM) as a recipient of the CRM Excellence Award in both 2006 and Despite the identification of process-centricity as critical to customer service success, very few vendors actually provide process-centric technology. Forrester Research found only five when it conducted its Forrester Wave, Q2 07. In the process-centric customer service management space, Pegasystems is the clear leader. Pegasystems Customers: Using Award-Winning Technology to Win Their Own Awards Healthcare payers are achieving new service levels while controlling costs using Pegasystems Customer Process Manager for Healthcare (CPMHC) solutions for both members and providers. Built on Pegasystems market-leading, business process management (BPM) platform, Customer Process Manager for Healthcare solutions automate common service requests and, through intent-driven processing, anticipate customer needs so that Customer Service Representatives (CSRs) have the necessary tools to deliver personalized and responsive service. These solutions deliver value from back-end data and processing silos, provide agility to meet changing business requirements, and facilitate compliance with internal and external regulations. CRM is becoming customer process management. Process innovation is key to delivering a branded customer experience that will differentiate your company from competitors - Forrester Research 2

5 Member Health and CSC deployed CPM-HC for Member Services within 90 days in In May, 2007, their Medicare Part D Prescription Drug Plan (PDP), CCRx, was named number one in overall customer satisfaction by Wilson Health Information. Blue Cross Blue Shield of Rhode Island uses Pegasystems to service both its members and its providers. In November, 2007 Service Quality Management announced BCBS RI as winner of its North American Call Center Service Quality Award of Excellence. BCBSRI won the award for performing at world class customer satisfaction and call resolution levels for six months or more and improving their customer satisfaction and fi rst call rate by more than 8%. Aetna, which has used Pegasystems for their customer service solution since 2005, ranked first in three states in a large customer survey released early in In December, 2007, Aetna placed an advertisement in the Wall Street Journal highlighting their superior customer service based on the results of a UBS Benefi ts Consultant Survey. Overall, the product has the best platform in the BPM space and has capabilities that other BPMs do not - Forrester Research Blue Cross Blue Shield of Massachusetts, a Pegasystems customer since 2000, won three awards from the SQM Group in 2006, beating out more than 250 other call centers including Aetna and several other Blues plans. The awards included: Highest Customer Satisfaction within the Health Care Industry. This award was based upon actual customer feedback and recognized the contact center with the highest overall customer satisfaction rating. World Class Customer Satisfaction. This award was for achievement of 80 percent or higher of call center customers who rate their experience as very satisfied based upon direct feedback from members. First Call Resolution Improvement Merit Award. This award went to call centers that increased their fi rst call resolution rate by 10 percent over the previous year. 3

6 High-level features of Pegasystems Customer Process Manager for Healthcare include: Intelligent, multi-channel interaction management One-and-done service process automation Real-time integration with legacy systems without replication or consolidation Predictive servicing for next best actions and offers Goal-based customer experience management Sophisticated SLA and work management functions Real-time, interactive analytics High-level benefits of Pegasystems Customer Process Manger for Healthcare include: Improved customer experience & loyalty Improved user productivity and reduced cost of service Improved quality of service Ability to differentiate service by customer value Consistency across and within interaction channels Increased management control and insight Build for Change technology enables rapid time to market and continual improvement Representative Results: 65% increase in customer retention 50% improvement in fi rst call resolution rates 75% reduction in handle time 60% reduction in training time 80% reduction in manual steps 100% increase in cross-sell/up-sell rates 100% increase in new business sales 35% grade of service improvement 83% reduction in abandonment rates 4

7 Representative Processes - Customer Management Smart view customer data composite (member, provider, provider group, policy, contact and plan sponsor) - General information and profile - Multi-channel interaction history - Service history - Claim search and review - Authorization search and review - Credentials Customer Surveys Add a Contact /Quick Add a Contact Updated Contact Name and Profile Update Contact Address and Profile Representative Processes - Service Processing Add a Newborn Appeal Prior Authorization Denial Complaint/Compliment Diagnostic/Knowledge Management Dispute a Claim Enroll in a Provider Network Frequently Asked Questions General Service Case Manage National Provider ID Materials Fulfillment Member Eligibility Member Search Order ID Card Request Prior Authorization Schedule Activity (call, appointment, task) Send Correspondence Update Member Address, Birth date, Name Update Primary Care Physician Updated Privacy Settings Update Provider Credentials Update Provider Profile 5

8 About Pegasystems Pegasystems (NASDAQ: PEGA), the leader in Business Process Management, provides software to drive revenue growth, productivity and agility for the world s most sophisticated organizations. Customers use our award-winning SmartBPM suite to improve customer service, reach new markets and boost operational effectiveness. Our patented SmartBPM technology makes enterprise applications easy to build and change by directly capturing business objectives and eliminating manual programming. SmartBPM unifies business rules and processes into composite applications that leverage existing systems empowering businesspeople and IT staff to Build for Change, deliver value quickly and outperform their competitors. Pegasystems suite is complemented by best-practice frameworks designed for leaders in financial services, insurance, healthcare, government, life sciences, communications, manufacturing and other industries. Headquartered in Cambridge, MA, Pegasystems has offices in North America, Europe and Asia. Visit us at Copyright 2011 Pegasystems Inc. All rights reserved. PegaRules, Process Commander, SmartBPM and the Pegasystems logo are trademarks or registered trademarks of Pegasystems Inc. All other product names, logos and symbols may be registered trademarks of their respective owners.