1.
SalesForce Redesign – Training 2
August 17, 2015
Sophia Myers

2.
• Context: In the wake of the dysfunctional implementation of
Healthcare.gov, my company, Lewin Group (UnitedHealth
Group/Optum), was brought in to help identify issues, strategize
solutions and manage a new course.
• Description of this Document: I prepared and delivered this
presentation in order to describe our strategy to the client and get
buy-in from other stakeholders. It includes our vision for the client
and the value it would bring to their organization; in addition, it
includes details about the particulars of how our goals would be
achieved using process flow diagrams and schematics.
2
Background

3.
Outline
Section 1
•Recap of Implementation
Section 2
• Caller and CSL Types and Subtypes
Section 3
•Components of CSL in SalesForce 2.0
Section 4
•Processing a Case – Start to Finish
Section 5
•Examples

4.
RECAP OF IMPLEMENTATION
Section 1:

5.
Goals of Implementation
Goal 1
• Decrease the time it takes to process a case
Goal 2
• Reduce the number of hand-offs for a given case
Goal 3
• Reduce the number of times a consumer is contacted
Goal 4
• Enable reporting

6.
Process Changes
•To achieve these goals, we have made 2 major
changes to improve how cases are processed:
1) Tiered Process
2) SalesForce Redesign
6

7.
Part 1 of Implementation: Tiered Process
• Three tiers to
process cases
• Different teams
within Tier 2 to
process different
types of cases

8.
Part 2 of Implementation: SalesForce Redesign
Changes to
SalesForce
Create CSL types and
subtypes
Create intake templates
for each CSL subtype
Route CSLs to the correct
processing team based on
CSL type and subtype
Process
Improvements
Standardize the way calls
are categorized into call
types
Collect all required
information – based on
the call type – at intake
Enable automatic routing
of CSLs (to the correct
processing team) – based
on the call/CSL type

9.
CALLER AND CSL TYPES AND
SUBTYPES
Section 3:

10.
Defining a case: Caller Types and Subtypes
IVL
Applied for
Financial
Assistance
Did NOT apply
for financial
assistance
Assistance
unknown
SHOP
Employers
Employee Non-
Congressional
Employee
Congressional
Internal
User
IPA/CAC
Broker
HBX Employee
Medicaid
Caller
Types
Caller
Subtypes

11.
Defining a case: IVL CSL Types and Subtypes
App.
Assist.
New
App
Request
for
IPA
Paper
App
Subm’d
Child
Only
Enrllmt
Close
App
Open
Enrllmt
Reqst
New
enrllmt
Plan
Change
Effective
Date
Change
Add
Dedpt
Gen.
Inquiry
Elig./
Cov Qs
DCHL/
Carrier
Info
Renewal
General
Q
Tech
Issue
UN/
PW
Reset
Security
Q/
Acct
Lockout
Missing
'Enroll in
Plans'
Link
Getting
an Error
Msg
IC or
PDC
Missing
Enrllmt
Issue/
Inquiry
Status
Inquiry
Carrier
Doesn’t
Have
Enrllmt.
Term/
Cancel
or
Rem.
Depdt
Request
for Term
Request
for
Cancel
Remove
Depdt.
Change
of Info
Address
Change
(within
DC)
Address
Change
(outside
DC)
Phone/
Email
Change
Name
Change
SSN
Change
Gender
Change
DOB
Change
Special
Enrllmt
Reqst
New
enrllmt.
(outside
OE)
Plan
Change
Effective
Date
Change
Reinst.
Request
Add
Dedpt
Life
Event
Income
Change
Newbor
n
Marriag
e/Divorc
e
Loss of
MEC
Moved
to DC
Change
in Legal
Status
Death
Billing
Qs
APTC/
Prem.
Incorrect
Paymen
t or
Billing
Inquiry
1095-A
and
Tax Qs
Dwnld.
Issue
1095-A
Cancel.
Missing
1095-A
1095-A
Inquiry
1095-A
Corr.
Inquiry
Tax
Penalty
Qs
Appeal
General
Appeal
Inquiry
F/U on
Filed
Appeal
File an
Appeal
Docu-
men-
tation
Verifi-
cation
Qs
Verifi-
cation
Docs

12.
Defining a case: IVL CSL Types and Subtypes
App.
Assist.
New
App
Request
for
IPA
Paper
App
Subm’d
Child
Only
Enrll
Close
App
Open
Enrllmt
Reqst
New
enrllmt
Plan
Change
Effective
Date
Change
Add
Dedpt
Gen.
Inquiry
Elig./
Cov Qs
DCHL/
Carrier
Info
Renewal
General
Q
Tech
Issue
UN/
PW
Reset
Security
Q/
Acct
Lockout
Missing
'Enroll in
Plans'
Link
Getting
an Error
Msg
IC or
PDC
Missing
Enrllmt
Issue/
Inquiry
Status
Inquiry
Carrier
Doesn’t
Have
Enrllmt.
Term/
Cancel
or
Rem.
Depdt
Request
for Term
Request
for
Cancel
Remove
Depdt.
Change
of Info
Address
Change
(within
DC)
Address
Change
(outside
DC)
Phone/
Email
Change
Name
Change
SSN
Change
Gender
Change
DOB
Change
Special
Enrllmt
Reqst
New
enrllmt.
(outside
OE)
Plan
Change
Effective
Date
Change
Reinst.
Request
Add
Dedpt
Life
Event
Income
Change
Newbor
n
Marriag
e/Divorc
e
Loss of
MEC
Moved
to DC
Change
in Legal
Status
Death
Billing
Qs
APTC/
Prem.
Incorrect
Paymnt
or Billing
Inquiry
1095-A
and
Tax Qs
Dwnld.
Issue
1095-A
Cancel.
Missing
1095-A
1095-A
Inquiry
1095-A
Corr.
Inquiry
Tax
Penalty
Qs
Appeal
General
Appeal
Inquiry
F/U on
Filed
Appeal
File an
Appeal
Docu-
men-
tation
Verifi-
cation
Qs
Verifi-
cation
Docs

13.
CSL Types: Terms, COI, Special Enrollment Requests, Life
Events
Term/Cancel
or
Remove
Dependent
Request for Term
Request for
Cancel
Remove
Dependent
Change of
Information
Address Change
(within DC)
Address Change
(outside DC)
Phone/
Email Change
Name Change
SSN Change
Gender Change
DOB Change
Special
Enrollment
Request
New enrollment
(outside OE)
Plan Change
Effective Date
Change
Reinstatement
Request
Add Dependent
Life Event
Income Change
Newborn/
Adoption
Marriage/
Divorce
Loss of MEC
Moved to DC
Change in Legal
Status
Death
Do NOT require a SEP Require a SEP
Policy Changes outside Open Enrollment
Remove 1 or all
members frm policy
No
QLE
Experienced
QLE
Demographic
Changes

14.
COMPONENTS OF CSL IN
SALESFORCE 2.0
Section 2:

15.
Components of a CSL
• Contact
• Representative
• Case Definition
• Template
• Status
• Queue
• CSL Owner
• CSL Assigned To
15

16.
Contact
• Consumer on phone/email
– Must be on the policy or application
– Does not need to the be primary
– Must search for existing contact, not free entry
16

17.
Representative
• Use only if person you are speaking to is not on the application or
policy but is calling for someone else
– Free Text
– Check for Authorized Representative Form
17

18.
Case Definition
18
• Identifies Caller and Case Type
– These fields should NOT change throughout the lifecycle of the
case (if correct)

19.
Case Definition and Templates
19
Caller Type
Caller Sub Type
CSL Type
CSL
Subtype
Template

20.
Template
20
•Each case definition combination has a unique template
•Captures necessary information for case to be processed

21.
Template
21

22.
Status
22
•Dynamic field that changes through the lifecycle of a case
•Functions as a trigger to move cases between queues
•**Not all Statuses Available to All Tiers

23.
Status
23
• In Progress
• Waiting on Consumer
• Ready for Tier 1 Processing
• Ready for Tier 2 Processing
• Ready for Documentation Verification
• Requires Technical Input
• Ready for EDI processing
• Waiting on Carrier
• Waiting on SEP Review
• Transmitted to Carrier
• EDI Action Complete, No Transmit Req’d
• Requires Tier 2/3 Input
• Requires Outreach – Info Needed
• Requires Outreach – Case Resolved
• Requires Correction
For use by Tier 1
Available to Tier 2 & 3
Coming back to Tier 1

24.
Status
24
Caller Type
Caller Sub Type
CSL Type
CSL
Subtype
Template
Queue:
• IVL: Tier 1 Team
• SHOP: Tier 1 Team
• Tier 1 Holding Bin
• IVL: Tier 1-Processing Team
• IVL: Tier 2-Enrollment Team
• IVL: Tier 2-Life Event Team
• IVL: 1095-A Team
• SHOP: Tier 2 Team
• SHOP: Implementation Team
• SHOP: Account Management
Team
• EDI
• O&M
• Appeals
STATUS

25.
Queues
• Indicates which group is responsible for working a case
• Changes throughout the lifecycle of case
• Not editable
• Each combination of case definition and status leads to queue
• Where case workers will pull work from

26.
Queues

27.
CSL Owner
• Indicates who is responsible for seeing the case through to
resolution
• Initially CSL Owner = CSL creator
• Can only stamp your own name, cannot make owner someone else
• Tier 2 Case workers will make themselves the owner when they claim
a case.
27

28.
CSL Assigned To
• Indicates who is currently responsible for working a case
• Used to ask for input/help other agents
28

29.
PROCESSING A CASE – START TO
FINISH
Section 4:

30.
Steps: Overview
•Step 1: Determine if contact exists
•Step 2: Determine if CSL already exists for the issue
•Step 3: Define case (select caller &CSL types and subtypes) &
complete template
•Step 4: Close CSL or select appropriate status to send to another
resolution team

31.
Step 1: Determine if contact exists
31
Job Aid 1.1: Intake
• Determine if a contact exists for the consumer
• If YES, a contact already exists, use existing contact
•If NO, no contact exists, create NEW contact

32.
Step 2: Determine if CSL exists
32
Job Aid 1.1: Intake
• Determine if a CSL exists for the issue
• If YES, a CSL already exists, use existing CSL
•If NO, no CSL exists, create NEW CSL

33.
Step 3: Define case, then complete template
33
Define Case
Step 1:
Select Caller Type
Step 2:
Select Caller Subtype
Step 3:
Select CSL Type
Step 4:
Select CSL Subtype
Complete Template

34.
Define Case – Step 1 : Choose a Caller Type
Job Aid 1.1: Intake

35.
Define Case – Step 2: Choose a Caller Subtype
Job Aid 1.1: Intake

36.
Define Case – Step 3: Choose a CSL Type
Job Aid 1.1: Intake

37.
Define Case – Step 4: Choose a CSL Subtype
Job Aid 1.5: Term/Cancel or
Remove Dependent
Choose correct job aid
based on CSL Type!

38.
Fill out the template!
Template
Job Aid 1.5: Term/Cancel or
Remove Dependent

39.
Template Tips: Basics
Enter
comments/
addtl. info here
Collect info
on primary
here Text in green
are reminders
for the CSR
Clicking
checkboxes
displays addtl.
info

40.
Template Tips: Moving between subtypes
40
FROM CSL Subtype: Address Change (within DC)
TO CSL Subtype Address Change (outside DC)
Information remains
within template, even as
you change the CSL
subtype!

41.
Step 4: Close CSL or select appropriate
status
• If the issue has been resolved, CLOSE the CSL
• If the issue has NOT been resolved, SELECT THE APPROPRIATE
STATUS
• 2 purposes of the status:
– 1) Describe what is currently happening to the CSL/case
– 2) Tells SalesForce what needs to happen next to the case,
in other words, where it needs to go next
• Some statuses are only available for certain subtypes, for
example the status ‘Requires technical input’ is only available
for CSL subtype: Technical Issues
• Some statuses are only available for certain Tiers
41

42.
Step 4, continued: Statuses
• CSR needs info from a manager before the CSL can be processed1. In progress
• CSR needs info/documentation from the consumer before CSL can
be processed, e.g. income amounts or income documentation
2. Waiting on
consumer
• CSL is complete & ready for processing by Tier 2
3. Ready for Tier 2
processing
• CSL is complete & ready for processing by Tier 1
4. Ready for Tier 1
Processing
• Consumer provided documentation, for example a pay stub, that
requires verification
5. Ready for
documentation
verification
• For technical issues that cannot be resolved by Tier 2
6. Requires technical
input

43.
1. In progress
2. Waiting on
consumer
3. Ready for Tier 2
processing
4. Ready for Tier 1
Processing
5. Ready for
documentation
verification
6. Requires technical
input
Step 4, continued: Statuses
What subtypes is the status
available for?
Where does the status send the
case?
-Request for term -Request for cancel
-Address change (within DC)
All
Tier 1 Processing Team
All
All
(except subtypes outlinedbelow)
Nowhere; case stays with Tier 1
Tier 2 Team
-Verif. docs -Income change -Marriage
-Add dependent -Moved to DC
-Change in legal status
ESA SWAT
-Username/passwordreset
-Security Q Reset/Account Lockout
O&M Technical Team
Tier 1 Holding Bin

44.
EXAMPLES
Section 5:
44

45.
IVL CSL Type: Technical Issue, CSL Subtype:
Username/Password Reset
• Collect primary details
• Question #1: Did you resolve the issue?
– If YES,
• No template because there is no need to collect any
information!
• A note appears reminding you to close the CSL!
– If NO
• Template appears that includes the following fields:
– Username
– Describe the error
• Only status options are “In Progress,” “Waiting on Consumer”
and “Requires Technical Input”
– Select “Requires Technical Input” to send it to O & M
45

46.
IVL CSL Type: Technical Issue, CSL Subtype: Getting an
Error Message
• Collect primary details
• Question #1: Did you resolve the issue?
– If YES,
• No template because there is no need to collect any
information!
– If NO
• Template appears
• Save the CSL and then attach a screenshot
• If the consumer has a complete application, and already knows
what plan they want, click the checkbox: Manual enrollment
template
– Template appears to collect manual enrollment info
• Only status options are “In Progress,” “Waiting on Consumer”
and “Ready for Tier 2 processing”
– Select “Ready for Tier 2 Processing” to send it to Tier 2
46

47.
IVL CSL Type: Change of Information, CSL Subtype:
Address Change (within DC)
47
To whom does the change apply?
Fill in if address change applies to other members on the policy

48.
IVL CSL Type: Enrollment Issue/Inquiry, CSL Subtype:
Status Inquiry
48
Were you able to determine the status?
YES NO
Submitted
If you were able to determine the
status, check this box. Close the CSL.
If you were not able to determine
the status, DO NOT check this box.

49.
CSL Type: Term/Cancel Plan or Remove Dependent, CSL
Subtype: Request for Termination
49
IVL: Tier 1 Processing Team
Copy the plan name from Glue
Use Address Change
(outside DC) for
permanent address
changes requiring plan
termination
!

50.
IVL CSL Type: Special Enrollment Requests, CSL Subtype:
New Enrollment (outside Open Enrollment)
• First, select SEP justification
• SEP justification determines template
– Qualifying Exceptional Circumstance
• Can be done through the system
• Collect the QualifyingExceptional Circumstancein the CSL
– American Indian/Alaska Native
• Can be done through the system
• Nothing to collect in the CSL
– Exchange, Assister or Carrier error
• Cannot be done through the system
• Must be reviewed by the SEP review team
• Collect details about the error in the template
– None of the above
50

51.
Caller Type: SHOP Caller Subtype: Employee – Non Congressional
CSL Type: Employee CSL Subtype: Life Event
51

52.
Caller Type: SHOP Caller Subtype: Employer
CSL Type: Change of Information CSL Subtype: Primary Contact
Change
52