Industry
Healthcare
Services
Implementation & Consultation
Solution
CSM, GRC
Region
USA
The leading health insurance provider turned to Aelum Consulting’s ServiceNow experts to improve efficiency, enhance data visibility, and streamline operations.
The Company: Trusted Health Insurance Provider
A renowned health insurance provider serving over 2 million members across Georgia, US. With a comprehensive portfolio covering individual, family, and employer-sponsored health plans, the organization manages complex member interactions across seven distinct personas including subscribers, dependents, brokers, and healthcare providers. As a trusted insurer with over three decades of experience, they continually invest in technology to enhance member engagement and streamline care coordination.
The Challenge
From fragmented persona management to unified, secure member experiences
The client’s operations were hindered by disconnected systems, inadequate data security protocols, and limited visibility into member interactions, impacting service quality and compliance. Their primary challenges were:
- Struggled to efficiently manage seven distinct user personas; members, dependents, providers, brokers, and internal teams leading to fragmented experiences and operational inefficiencies.
- Faced challenges securing sensitive member health data across multiple touchpoints, creating compliance risks and threatening member trust in a regulated environment.
- Unable to deliver tailored recommendations and emergency doctor suggestions through existing systems, resulting in suboptimal member engagement and care coordination.
- Lacked dashboards providing real-time insights into member activities, case statuses, and service performance across different personas and workflows.
The Goal
The company aimed to transform member engagement by providing personalized healthcare recommendations and emergency doctor suggestions. Key objectives included streamlining persona management, strengthening data security and governance, enhancing operational visibility through analytics, and delivering an intuitive portal experience.
The Solutions
Transforming member experience and insurance operations with ServiceNow
Recognizing the client’s need, Aelum Consulting implemented ServiceNow CSM, GRC, and Performance Analytics to create secure, personalized member experiences and streamlined operations. The key solutions provided were:
- ServiceNow CSM: Implemented tailored workspaces for seven unique personas, enabling customized interfaces and workflows that improved member engagement and simplified agent operations.
- ServiceNow GRC: Deployed comprehensive governance, risk, and compliance frameworks to secure sensitive member health data, ensure regulatory compliance, and strengthen data protection protocols.
- ServiceNow Performance Analytics: Created supervisor workspaces with 360-degree visibility into member activities, case statuses, and performance metrics, enabling data-driven decision-making and proactive support.
- Unified Member Portal: Built an intuitive, feature-rich portal integrating personalized recommendations and emergency doctor suggestions, replacing legacy agent workspace with enhanced functionality and user satisfaction.
ServiceNow Tech Stack used:
ServiceNow CSM, GRC, Performance Analytics
The Outcomes
After the successful implementation of ServiceNow solutions, the client experienced significant improvements in operational efficiency, data security, member engagement, and user satisfaction, positioning the insurer as a leader in digital healthcare experiences. The company achieved:
- Improved Efficiency: Streamlined operations and made it easier to manage different personas.
- Enhanced Data Visibility: The supervisor workspace provided comprehensive insights into member activities and case statuses.
- User Satisfaction: The custom portal addressed user dissatisfaction with the previous agent workspace, offering a more intuitive and feature-rich environment.