Curate trusted, member-centric experiences in every interaction with humans and AI agents working together to serve members, providers, brokers and partners on a unified platform. Automate workflows across enrollment, claims management, and member engagement to boost productivity and long-term satisfaction all with an industry-specific, AI-powered healthcare CRM.
Guide members through a connected health journey and transform interactions into trusted relationships.
Empower service teams with the right tools for success. Improve service team productivity with intelligent workflows powered by Agentforce. Automate caller validation, streamline relationship mapping, track interactions seamlessly, and simplify call wrap-ups—all within a connected, AI-driven platform.
Easily audit caller interactions to ensure compliance and maintain a high standard of quality across the spectrum of digital channels.
Create personalized inbound and outbound interactions with real-time 360-degree views that offer relevant member, provider, and third-party partner information.
Leverage the power of a single, connected system to quickly grow, manage, and improve collaboration across your network of quality providers.
Manage the contract lifecycle, track negotiations, and capture communications to support strategic provider relationship management decisions, while optimizing reimbursement rates and ensuring regulatory compliance. Leverage a 360-degree view of each provider with unified data across channels.
Accelerate provider credentialing from weeks to days and improve data quality with direct-to-source integrations, automated primary source verification, and continuous ongoing monitoring.
Consolidate provider information into a single operational data layer, enabling roster management, data validation, and seamless integration across systems to improve operational efficiency and maintain accurate provider directories.
Enable providers to see the status of their applications and conveniently manage their profiles, issue resolution, and care processes — with intuitive, easy-to-use portals — focusing on a better provider experience, higher provider engagement.
Empower care teams to achieve cost-effective outcomes and experiences.
Conduct comprehensive medication reviews, reconcile therapies, detect drug-to-drug interactions, and document discrepancies and recommendations.
Unify sources of member health data like claims, labs, pharmacy, EMR, assessments, and social determinants to drive stratification insights.
Calculate unified health scores, identify at-risk members, and enroll them in care programs to address their needs and improve adherence.
Transform quoting, enrollment, benefits management, and renewals to seamlessly convert and retain members.
Accelerate your leads and relationships with actionable data and predictive AI for small and large groups.
Save your sales team time with automated emails and next best actions that leverage account insights.
Provide a seamless enrollment experience for your employee admins and brokers with options to quickly filter, compare, and check out.
Speed time to care with electronic intake, review, and tracking of prior authorizations, concurrent or retro-reviews. Automate workflows and leverage AI to drive reporting and compliance throughout the authorization process. Proactively mitigate against SLA breaches and ensure timely responses that are customized to member plan and service.
Eliminate back-and-forth processes with DaVinci-compliant FHIR APIs, enabling providers to electronically submit and track requests in real time. Equip admin teams with a unified view of all member interactions, documentation, and automated form field extraction—enhancing accuracy and efficiency across channels.
Intelligently route and prioritize requests to the appropriate reviewers to ensure rapid responses. Assess medical necessity with evidence-based criteria to enable appropriate care determinations. Promote transparency into approved, denied, and appealed claims with real-time coverage alerts.
Leverage AI-powered insights to identify historical diagnosis patterns and determine auto-approval rules for common procedures. Use predictive analytics to manage network adequacy, make intelligent decisions to improve program effectiveness, and maintain compliance for regulatory standards.
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Health Cloud is a healthcare payer administration software that allows health plans to influence better health decisions, improve the member and broker experience, and reduce the cost of care through collaboration. Learn more
Payers need a single source of truth for all their member, broker, and provider data. Rather than siloed point solutions, it is crucial to have a consolidated view of everything on a connected platform. This drives productivity and optimal services and outcomes.
Health Cloud advances the ability of healthcare systems to drive stronger member relationships with out-of-the-box functionality. With it, organizations can manage the entire member journey from prospect to enrollment, provider selection, benefits administration, service, care support, billing, and more.
Look for a solution architected for flexibility with tools that help you deliver innovation quickly. Consider the total cost of ownership of any healthcare solution including the ability to integrate with other digital and third-party solutions, uptime, access to advanced features, ongoing support, and implementation.
