Member Portals Built with the Power of Salesforce

Solving the Use Case

Overview

With the right configuration and feature set, Salesforce Experience Cloud can transform the way payers deliver support, giving members on-demand access to policy details, claims details, deductible amounts, and billing. Salesforce Experience Cloud is a scalable foundation for these experiences, and it needs to be customized.

To get things started, we define the personas, permissions, and roles in Experience Cloud. These roles are created to fulfill the needs of plan administrators and members. The most basic structure looks like this:

• Plan Administrator
• Member
• Portal Administrator

Configuring Experience Cloud for Members

Experience Cloud configurations build branded portals that improve brand equity and provide policy details, in-network providers, member information, and claims access.

Brand Equity

The multitude of stakeholders members interact with in their healthcare experience can often be confusing. This is why effective branding in healthcare is crucial – and the portal is a great opportunity to be brand-forward. As a result, we customize every portal with payer logos and color schemes. This approach creates a strong association between the brand and the exceptional experience awaiting members.

Member Details

Whether they need their member ID for a routine check-up or their HSA balance, members need quick access to their insurance details. A prominent member page gives users a quick view of their most important plan details. We typically configure this member detail screen to include:

• Member ID
• Plan ID
• Group ID
• Link to Benefit Card
• Deductible
• Out-of-Pocket Maximum
• HSA, FSA, or HRA Balance

We also configure this page to make other information "one-click" away. This makes information such as prescription drug coverage, benefit summaries, claims statuses, and contact information quickly accessible.

Provider Search

A provider search component gives members a way to find the best providers for a variety of services. They can search by speciality, location, provider group, and more. This helps members find in-network providers that offer the services they need, without needing to contact a support representative.

Claims Details

A dedicated claims area gives members insights into the claims that are in progress, approved, or denied. Claims are tagged by category, including diagnoses, procedures, supplies, medicines, medical devices, or transport. Claims are clearly marked by the provider who submitted them, making it easy for members to find claims for specific events by date or service charge.

By offering a portal that gives members fast access to policy details, in-network providers, claims, and support, payers can significantly reduce administrative burden while increasing member satisfaction.