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Salesforce - Client Strategy Presentation

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I prepared and delivered this presentation 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.

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Salesforce - Client Strategy Presentation

  1. 1. SalesForce Redesign – Training 2 August 17, 2015 Sophia Myers
  2. 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. 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. 4. RECAP OF IMPLEMENTATION Section 1:
  5. 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. 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. 7. Part 1 of Implementation: Tiered Process • Three tiers to process cases • Different teams within Tier 2 to process different types of cases
  8. 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. 9. CALLER AND CSL TYPES AND SUBTYPES Section 3:
  10. 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. 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. 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. 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. 14. COMPONENTS OF CSL IN SALESFORCE 2.0 Section 2:
  15. 15. Components of a CSL • Contact • Representative • Case Definition • Template • Status • Queue • CSL Owner • CSL Assigned To 15
  16. 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. 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. 18. Case Definition 18 • Identifies Caller and Case Type – These fields should NOT change throughout the lifecycle of the case (if correct)
  19. 19. Case Definition and Templates 19 Caller Type Caller Sub Type CSL Type CSL Subtype Template
  20. 20. Template 20 •Each case definition combination has a unique template •Captures necessary information for case to be processed
  21. 21. Template 21
  22. 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. 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. 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. 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. 26. Queues
  27. 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. 28. CSL Assigned To • Indicates who is currently responsible for working a case • Used to ask for input/help other agents 28
  29. 29. PROCESSING A CASE – START TO FINISH Section 4:
  30. 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. 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. 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. 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. 34. Define Case – Step 1 : Choose a Caller Type Job Aid 1.1: Intake
  35. 35. Define Case – Step 2: Choose a Caller Subtype Job Aid 1.1: Intake
  36. 36. Define Case – Step 3: Choose a CSL Type Job Aid 1.1: Intake
  37. 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. 38. Fill out the template! Template Job Aid 1.5: Term/Cancel or Remove Dependent
  39. 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. 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. 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. 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. 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. 44. EXAMPLES Section 5: 44
  45. 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. 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. 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. 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. 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. 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. 51. Caller Type: SHOP Caller Subtype: Employee – Non Congressional CSL Type: Employee CSL Subtype: Life Event 51
  52. 52. Caller Type: SHOP Caller Subtype: Employer CSL Type: Change of Information CSL Subtype: Primary Contact Change 52

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