2Overview of Siebel Healthcare
Overview of Siebel Healthcare
This chapter describes the modules of Siebel Healthcare and their functionality. It includes the following topics:
About Siebel Healthcare
Oracle’s Siebel Healthcare includes various modules that you can mix and match according to your business needs.
Siebel Healthcare is built upon the Siebel Business Architecture, which includes Siebel Sales, Siebel Service, and Siebel Call Center applications. Like many other Siebel Business Applications,Siebel Healthcare uses the Siebel Data Model, the Siebel Object Architecture, and the Siebel Application Server Architecture.
Siebel Healthcare Functionality
Siebel Healthcare offers a solution for relationship management in the healthcare market that includes the health insurance, employee benefits, and care delivery sectors. Built on the strengths of Siebel Industry Applications, Siebel Healthcare allows organizations to successfully manage relationships throughout the entire customer lifecycle, across all stakeholder touchpoints. This provides a platform for identifying new opportunities and expanding upon existing business relationships. Recognizing that success comes from relationships with the expanded community of stakeholders, Siebel Healthcare’s suite of applications focus on the expanded healthcare ecosystem: insurance subscribers and members as well as employer accounts, independent brokers, direct sales channels and providers (health systems, physicians, hospitals, networks, ancillary providers).
By using Siebel Industry Applications, Siebel Healthcare provides solutions to address the industry's most pressing business issues.
The Siebel Healthcare solution sets include:
End-to-End Sales
Manage Opportunity and Account Tracking for prospecting, renewal, and lost business analysis
Team based selling (including external team members such as brokers)
Sales Manager views to facilitate team management
Embedded Sales strategy tools
Capture of information for rating and underwriting such as census and health risk assessment
Automation capabilities to make sure that quotes and installed cases move through the organization
Agent/Broker/Consultant Solutions
Profiling capabilities to track licenses, appointments, errors & omissions coverage, agency affiliation
Ability to assign an agent or broker to an opportunity or account
Management tools to assess the relative value of various selling partners
Delegated administration to allow agencies to administer their own user names and passwords
Group Account Relationship Management
Ability to communicate new product information and tailored messages about the plan consistently across every interface
Streamline the open and dynamic enrollment processes. Employees can self-enroll online or administrators can submit enrollment by using the group portal
Manage service issues with analytics and reports. Employers can have visibility into aggregate claims data, physician networks and other relevant plan information
Promote online self-service as an avenue for quick resolution of billing issues
Agent Tools
Support demand from web, fax, phone and email from a single interface
Address common inquiries with a dashboard of eligibility information, claims history, service history, and log of customer interactions
Use assignment manager and workflow products to allow agents to follow best-practice procedures
Allow new agents to get up to speed through the use of scripting tools and a common solution library
Health Management
Use the Events module to track available health classes and clinics and enroll members and patients
Create Activity plans and use workflow tools to outline the appropriate activities and resources required to proactively manage care
Develop campaigns for managing enrollment of at-risk populations in care management programs
Provide information to educate members on critical life events, disease specific services, and available health classes
Use analytics capabilities to track and monitor the success of classes and programs
Provider Relationship Management
Consolidate critical information from back office systems related to individual physicians and other providers. This supports effective responses to inquiries and proactive management of the contracting relationship
Track key information on individual physicians such as panel size and status, location, office hours and hospital admitting privileges
Search for providers and facilities in a geographic radius using Geocode searching capabilities
Access provider information online using a secure website
Generate provider reports by specialty, product, or state
Offer provider portal to promote self-service for common inquiries
List of Reports
To see a list of the preconfigured reports available for the data in a view, click Reports in the toolbar while in the view. The list specifies which reports are available as Oracle Business Intelligence Publisher reports. From the list you can access individual reports.