SalesForce Redesign – Training 2August 17, 2015Sophia Myers

• 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.

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Background

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

RECAP OF IMPLEMENTATIONSection 1:

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

Process Changes

• To achieve these goals, we have made 2 major changes to improve how cases are processed:

1) Tiered Process

2) SalesForce Redesign

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Part 1 of Implementation: Tiered Process

• Three tiers to process cases

• Different teams within Tier 2 to process different types of cases

Part 2 of Implementation: SalesForce Redesign

Changes toSalesForce

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

ProcessImprovements

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

CALLER AND CSL TYPES AND SUBTYPES

Section 3:

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

MedicaidCaller Types

Caller Subtypes

Defining a case: IVL CSL Types and Subtypes

App. Assist.

New App

Request forIPA

Paper App

Subm’d

Child Only

Enrllmt

Close App

Open EnrllmtReqst

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

Newborn

Marriage/Divorc

e

Loss of MEC

Moved to DC

Change in Legal Status

Death

Billing Qs

APTC/Prem.

Incorrect

Payment 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

Defining a case: IVL CSL Types and Subtypes

App. Assist.

New App

Request forIPA

Paper App

Subm’d

Child Only Enrll

Close App

Open EnrllmtReqst

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

Newborn

Marriage/Divorc

e

Loss of MEC

Moved to DC

Change in Legal Status

Death

Billing Qs

APTC/Prem.

Incorrect

Paymntor 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

CSL Types: Terms, COI, Special Enrollment Requests, Life Events

Term/Cancelor

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 SEPPolicy Changes outside Open Enrollment

Remove 1 or all members frm policy

No QLE

Experienced QLE

Demographic Changes

COMPONENTS OF CSL IN SALESFORCE 2.0

Section 2:

Components of a CSL• Contact

• Representative

• Case Definition

• Template

• Status

• Queue

• CSL Owner

• CSL Assigned To

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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

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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

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Case Definition

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• Identifies Caller and Case Type– These fields should NOT change throughout the lifecycle of the

case (if correct)

Case Definition and Templates

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Caller Type

Caller Sub Type

CSL Type

CSL Subtype

Template

Template

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•Each case definition combination has a unique template

•Captures necessary information for case to be processed

Template

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Status

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•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

Status

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• 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

Status

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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

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

Queues

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.

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CSL Assigned To• Indicates who is currently responsible for working a case

• Used to ask for input/help other agents

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PROCESSING A CASE – START TO FINISH

Section 4:

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

Step 1: Determine if contact exists

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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

Step 2: Determine if CSL exists

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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

Step 3: Define case, then complete template

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Define Case

Step 1: Select Caller Type

Step 2: Select Caller Subtype

Step 3: Select CSL Type

Step 4: Select CSL Subtype

Complete Template

Define Case – Step 1 : Choose a Caller Type

Job Aid 1.1: Intake

Define Case – Step 2: Choose a Caller Subtype

Job Aid 1.1: Intake

Define Case – Step 3: Choose a CSL Type

Job Aid 1.1: Intake

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!

Fill out the template!

Template

Job Aid 1.5: Term/Cancel or Remove Dependent

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

Template Tips: Moving between subtypes

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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!

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

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Step 4, continued: Statuses

• CSR needs info from a manager before the CSL can be processed 1. 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 23. Ready for Tier 2 processing

• CSL is complete & ready for processing by Tier 14. 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 26. Requires technical input

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 outlined below)

Nowhere; case stays with Tier 1

Tier 2 Team

-Verif. docs -Income change -Marriage-Add dependent -Moved to DC

-Change in legal statusESA SWAT

-Username/password reset-Security Q Reset/Account Lockout O&M Technical Team

Tier 1 Holding Bin

EXAMPLESSection 5:

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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

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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

IVL CSL Type: Change of Information, CSL Subtype: Address Change (within DC)

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To whom does the change apply?

Fill in if address change applies to other members on the policy

IVL CSL Type: Enrollment Issue/Inquiry, CSL Subtype: Status Inquiry

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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.

CSL Type: Term/Cancel Plan or Remove Dependent, CSL Subtype: Request for Termination

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IVL: Tier 1 Processing Team

Copy the plan name from Glue

Use Address Change (outside DC) for permanent address changes requiring plan termination

!

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 Qualifying Exceptional Circumstance in 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

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Caller Type: SHOP Caller Subtype: Employee – Non CongressionalCSL Type: Employee CSL Subtype: Life Event

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Caller Type: SHOP Caller Subtype: EmployerCSL Type: Change of Information CSL Subtype: Primary Contact Change

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