Non-Profit Healthcare Payer Realizes Nearly $240,000 in Annual Savings through Salesforce Migration and Data Integration
Mastek partnered with an Arizona-based non-profit healthcare organization to modernize its customer service experience for the Medicare Advantage (MA) population, resulting in nearly $240,000 in annualized savings. By migrating to the Salesforce CRM and integrating multiple legacy systems, Mastek significantly improved call center efficiency, customer satisfaction, and regulatory compliance.
Client Snapshot
This non-profit organization provides nearly 2 million customers with health insurance and services, including Medicare Advantage plans designed for seniors and those with disabilities. The company employs over 3,000 staff members across three offices in the western region of the US, all dedicated to helping consumers get and stay healthy.
Challenge
Customer service representatives (CSRs) in the Medicare Advantage teams needed to swivel among five disparate, siloed applications to serve callers: HealthRules Payer (HRP) for claims data, OnBase for documentation, a NICE IVR system, Excel, and email. Because these systems weren’t integrated and lacked scalability, CSRs found it slow and cumbersome to handle common tasks like verifying caller identity for regulatory compliance, enrolling new members, and answering member or provider questions, especially as the member base grew. It was incredibly time-consuming just to create an issue within HRP, reducing staff productivity and hindering customer service.
As members grew more frustrated by high call handle times and delays, the client’s customer satisfaction ratings suffered – dropping as low as 2.5 out of 5 for one Medicare Advantage plan. It was clear the organization needed a more robust technology infrastructure to meet customer service expectations.
Solution
The healthcare payer tapped Mastek for the project based on our Salesforce migration experience and track record with other payers. Mastek kicked off the engagement in April 2023 with a technical discovery of the client’s systems from a Medicare Advantage (MA) line of business (LOB) perspective and then proposed that the MA Service teams could successfully move to the Salesforce CRM based on available infrastructure that was being used by other LOBs, creating a unified data view and improving process efficiency. Mastek completed this complex transformation in two phases totaling less than eight months.
Mastek resources also helped migrate the massive volume of data (including millions of claims), integrated multiple systems, conducted extensive testing, developed documentation, and led train-the-trainer sessions to support a smooth transition. Overall, close to 120 MA Service team members were migrated from HRP to Salesforce. The Mastek team worked closely with the client’s subject matter experts and internal project manager to complete the engagement on a seven-month timeline, going live with the first phase in September 2023 and the second phase in December 2023 while ensuring no impact to open enrollment.
Now Salesforce is the central platform for nearly 120 users including CSRs, leads, and managers across six Medicare Advantage teams, equipping them to provide a high-quality service experience. They can complete a call from start to finish within Salesforce, with a complete view of member demographics, group data, plan data, call history, provider data, claims history, and case status.
Impact
- Average call handle time dropped by 30%, saving 533 CSR hours/month - equating to $120,000/year.
- Post-call wrap-up time reduced by 50%, streamlining CSR workflows.
- The enrollment team saved 40 hours/month by reducing manual demographic validation.
- Faster prior authorization processing led to $31,000/year in savings.
- Care Gap data load time reduced from 10 hours to 30 minutes.
Process Improvements
- Automated Salesforce Case 360 Creation replaced a manual 2–6 minute lookup process, accelerating issue resolution by 50%.
- HIPAA verification was simplified with a new launcher, reducing risk and increasing speed.
- Communication preferences are now visible to CSRs, minimizing unwanted member contact.
Process Improvements
- Managers now create custom reports and dashboards on metrics like HIPAA verifications, open vs resolved cases, and resolution times.
- Improved reporting has cut down unproductive meetings and boosted operational visibility.
Looking Ahead
Encouraged by success, the client plans to migrate more business lines to Salesforce, leveraging it to enhance member, provider, and broker portals with self-service capabilities like ID card requests and claim status tracking.
Value Delivered
- Legacy systems consolidated on time and within budget.
- Cross-team savings across six departments.
- Faster, compliant, and more consistent customer service.
- Boosted CSR productivity and improved decision-making.
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