RP Sanjiv Goenka Group
Blue Shield of California

Agenda

Date: 14th – 15th February 2024

header
Start Time
21:15:00
Duration
00:15:00
Welcome at the center and Introductions
End Time
21:30:00
header
Start Time
21:30:00
Duration
00:30:00
Firstsource Overview
Service Offerings, Clients and Contact Center Experience
End Time
22:00:00
header
Start Time
22:00:00
Duration
01:00:00
Digitally Enabled Contact Center
Firstsense AI Health Plan Operations Transformation Assets
  • GenAI – Benefits Inquiry and Claims Status Inquiry Copilot
  • Instructional Design Copilot
  • Hiring and Training Simulator
  • Smart Mailbox Copilot
  • Guided Agent Navigation Support (Yonyx and SONAR)
  • Visual IVR and OnDemand Apps
  • Conversational AI Tools for Superior Experience
End Time
23:00:00
header
Start Time
23:00:00
Duration
00:10:00
Tea/Coffee Break
End Time
23:10:00
header
Start Time
23:10:00
Duration
00:45:00
Agent Lifecycle
Talent Acquisition, Talent Management, Training and Quality, Floor Support
End Time
23:55:00
header
Start Time
23:55:00
Duration
00:10:00
Workforce Management Solution Overview
Interval Level Staffing, Part Time Staffing, Capacity Planning, Gig Staffing
End Time
00:05:00
header
Start Time
00:05:00
Duration
00:15:00
Operations Session
Discussion with Healthcare Contact Center Associates
End Time
00:20:00
header
Start Time
00:20:00
Duration
00:10:00
Wrap-Up and Next Steps Discussion
End Time
00:30:00
Session Timing  Duration (Mins) Session Name
23:30 – 23:45 hrs 15 Welcome at the center and Introductions
23:45 – 00:15 hrs 30 Firstsource Overview Service Offerings, Clients and Contact Center Experience
00:15 – 00:30 hrs 15 Operations Session Discussion with Healthcare Contact Center Associates
00:30 – 00:45 hrs 15 Workforce Management Solution Overview Interval Level Staffing, Part Time Staffing, Capacity Planning, Gig Staffing
00:45 – 01:30 hrs 45 Agent Lifecycle Talent Acquisition, Talent Management, Training and Quality, Floor Support
01:30 – 01:45 hrs 15 Tea/Coffee Break
01:45 – 02:45 hrs 60 Contact Center Capability Overview Session
Firstsense AI Health Plan Operations Transformation Assets
  • GenAI – Benefits Inquiry and Claims Status Inquiry Copilot
  • Instructional Design Copilot
  • Hiring and Training Simulator
  • Smart Mailbox Copilot
  • Guided Agent Navigation Support (Yonyx and SONAR)
  • Visual IVR and OnDemand Apps
  • Conversational AI Tools for Superior Experience
02:45 – 03:00 hrs 15 Wrap-Up and Next Steps Discussion

Team Introduction

Anup Panthaloor

Anup Panthaloor

Sales and CRM

Rajesh Reddy

Rajesh Reddy

Client Services

Bikash Biyala

Bikash Biyala

Healthcare Operations

Philip Commeyne

Philip Commeyne

Healthcare Operations

Piya Malhotra

Piya Malhotra

Human Resources

Hiren Dhanecha

Hiren Dhanecha

Talent Acquisition

Reetoopan Kaushik

Reetoopan Kaushik

Training and Quality

Reyarvin Generale

Reyarvin Generale

Training and Quality

Kevin Pinto

Kevin Pinto

Administration

Location Overview

Talent Leadership

Talent Acquisition

Hiring the right talent is key to success of our programs

Talent Management and Retention

Employees Comes First

Capability Development

Learning Journey of our Employees

Inclusion and Diversity

We fully embrace an inclusive workplace culture

Our Spectrum of Offerings across the Health Plan Value Chain

Intelligent Back Office

Simplifying clinical and financial experience for patients and healthcare providers

  • Digitally Empowered Contact Center – Member and Provider services
  • Claims Operations
  • Enrollment Operations
  • Membership and Billing
  • Provider Data Management
  • Provider Credentialing
  • Complaints, Grievances and Appeals

Platform Based Services

Improving customer experience, driving digital transformation by leveraging Platforms and delivering underlying process efficiencies

  • Medicaid Redetermination
  • Digital Intake - Claims, Enrollment, Auth, Appeals, HEDIS, Correspondence
  • Corporate Mail to Email Digital Post-office Solution
  • Core Admin Business Process as a Service (BPaaS)

Digital Health Data & Analytics

Ensuring a seamless digital experience for Patients across all channel

  • Medical Devices
  • Patient Outreach
  • STAR, HEDIS
  • Risk-Adjustment
  • Medication Adherence
  • Process Mining
  • Predictive & Preventive AI
  • Generative AI Copilots
  • Intelligent Automation

Industry Analysts and Clients are endorsing Firstsource’s approach

Leader in Healthcare Payer Operational Transformation

Leader and Star Performer in Healthcare Payer Operations

logo 5

Innovator in Claims Processing Transformation

Logo 3

#1 in Eligibility and Enrollment Services

Leader/Rising Star in Healthcare Digital Services

Rising star in Payer BPaaS Services

Placed in BPS Top 10 Service Providers by Growth

Bloomberg

Recognized on Bloomberg Gender-Equality Index 2023

Intelligent Back-Office Operations

Contact Center

Transform every Member and Provider call to an exceptional experience that builds loyalty

Claims

Transform fragmented, manual and error-prone claims operations into Digital-First Operating Model

Provider Operations

Turn ordinary PDM and Credentialing processes into extraordinary provider & member experiences

Enrollment and Billing

Transform E&B transactions to delightful member experiences while providing timely access to care

Digital Intake

Turn ordinary mailroom processes into extraordinary experiences for everyone

FirstSenseAI

Intelligent Back-Office Operations

FirstSense AI - Suite of Gen AI Services across the Contact Center Value chain 01 05 03 07 02 06 04 08 09 Identify root causesto reduce the Incidence Rate with Process Mining Smart MailboxIdentify Intent, Classify, Route, Respond back, Create Ticket Prevent Process GenAI poweredChat (Live, BOT)Copilot Identify Intent, Summarize, Next Best Action AI-CoachHiring and TrainingSimulator GenAI CopilotBenefits Inquiry Copilot Visual IVROnDemand Apps Before the call Lands After the call Lands After the call ends Guided Response System SONAR, Instructional Design and Yonyx Copilot Conversational AI – Next Best Action, ACW AutomationAgent Initiated Digital Engagement, Sentiment analysis, Generative AI –Automated Quality Audits Predict Retrospect Click Here
FirstSense AI - Suite of Services across the Claims Operations Value chain Claims Intake Claims Adjudication Claims Payment & Financials Appeals & Grievances Claims Adjustment Claims Payment /Recovery ClaimsAudit Payment Integrity Click Here 01 05 03 07 02 06 04 08 Sympraxis® - Proprietary purpose-built data capture platform with multiple OCRs, AI/ML, Automation, and Analytics capabilities Enso Claims AI - Predicts and resolves claim suspensions without manual Intervention and executes real-time intelligent claim edits Enso Claims AI - Predicts and resolves claim suspensions without manual Intervention and executes real-time intelligent claim edits Generative AI –Automated Quality Audits Enso Claims Audit - Predicts and identifies claims with potential errors and provides reasons for errors Enso PaymentIntegrity COB - Predicts potential COB in real-timeusing a combinationof Member life eventsand claim data and recommends future actions SONAR - SOP Navigation & Review for manual adjudication SONAR - SOP Navigation & Review for manual adjustments Enso Appeals & Grievances - Predicts, classifies, and flags claims for potential appeals and grievances using LLMs and NLP SONAR - SOP Navigation & Review for over/under payments Process Mining - Process analysis and improvement AI-Coach - Hiring and Training Simulator SARA – Instructional Design Copilot​

Outcomes Delivered

Implemented Visual IVR for a Healthcare Services Company

Agents freed up, to focus on more complex interactions to increase agent engagement by diverting the various call types to self-serve Visual IVR channel.

Led to 80% average containment rate

Implemented Conversational AI for a US-managed healthcare company

Deployed Agent-assist solution (Voicebot and conversational AI for virtual agent self-service and conversational assistance) to provide associates with real-time advice.

Brought $6M Cost savings

Digital Decision Tree accentuating Agent Capability for a leading non-profit HMO Blues Plan

Implemented Decision tree to enhance call flow. Real-time edits or quick and efficient updates tiered toward process changes. Call flow templates for efficient call handling.

80% to 90% improvement in Quality Performance for new hires.

Reduction in ACHT by 25% leading to higher agent utilization

Supported leading Regional Blue Plan in exceeding call quality performance

Consistently supporting Client Staffing requirements adequately to meet Telephony Metrics over the last 24 months

Achieved monthly Call Quality Goal >= 91%, monthly FCR Goal >74%, monthly MTM <= 1 Error
Meeting and exceeding MTM goals for the last 9 months in a row

Helping customers stay ahead of the curve through transformational technologies and capabilities

Firstsource Solutions Limited, an RP-Sanjiv Goenka Group company, is a leading provider of transformational solutions and services spanning the customer lifecycle across Healthcare, Banking and Financial Services, Communications, Media and Technology and other industries.

Our ‘Digital First, Digital Now’ approach helps organizations reinvent operations and reimagine business models, enabling them to deliver moments that matter and build competitive advantage.

With an established presence in the US, the UK, India and the Philippines, we act as a trusted growth partner for over 100 leading global brands, including several Fortune 500 and FTSE 100 companies.

firstsource.com

Firstsource Solutions

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Eddie Monteiro

Eddie is currently Chief Operating Officer at Educational Testing Service (ETS), where he sets and drives the transformation agenda across the company and has responsibility for all technology and operations functions in addition to the College Board, K-12, and teacher licensure businesses. He previously ran business and technology services at Pearson, where he built a global team to enable scalable delivery of enterprise functions. Prior to that, while at IBM, he held several executive leadership roles in the US, Mexico and Brazil across a diverse set of industries and clients.
Geetha Krishnan

Geetha Krishnan

Geetha Krishnan consults with the Indian Institute for Human Settlements in Bangalore as Senior Advisor and Head of Digital Blended Learning, where he spearheads their online learning and continuing education portfolio. Over 25 years, Geetha has played senior roles in diverse sectors such as academia, online learning, and advertising. In his last role as Director – Centre for Executive Education at the Indian School of Business (ISB), Geetha was head of the profit center comprising more than 50 open enrollment and long duration programs and spearheaded ISB’s foray into online learning by enabling their partnership with Coursera.
Susan Aldridge

Susan Aldridge

Dr. Aldridge is an Executive Higher Education Consultant to university presidents and ministers of education regarding business models and technology-enhanced education. She recently retired from Drexel University after serving six years as president of Drexel University Online overseeing more than 125 online programs. During her six-year tenure as President of University of Maryland Global Campus (UMGC), she doubled the university’s enrollment to 97,000 – to become the largest public American university. She also served as Vice Chancellor for Troy University’s Global Campus managing online programs and satellite campuses in 12 countries and 17 states.

Alan Greenberg

Alan Greenberg

Previously Director Apple Education EMEA and APAC, Alan led the team that built Education Podcasting and iTunes U. He has worked on the development of Apple Education mobile strategy, iOS Education APPs, and developed the SEED CSR project in China, a collaboration between Apple, Foxconn, and Pearson. Executive Board of WideCells Group Plc, Group CBDO, and EVP & Founder of Wideacademy; his working contributions include multiple technology engagements providing domain expertise across digital, mobile, brand, scale-up, international business development, and venture capital.

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