Health Insurance Member Experience Technology

Improving member engagement reduces costs while also improving health outcomes. But scaling that engagement can be costly if you aren’t using the right tools and technology. With that in mind, here are some tips and technology to improve the health insurance member experience.

3 Tips when Implementing Member Experience Technology

When you’re shopping for health insurance member experience technology, there are three important considerations:

  1. Prioritize Based on Member Need — Don’t solve edge cases. Start small and look for technology that can improve common member actions. That may be searching for a provider, taking a health assessment, or accessing relevant information on the member portal. After addressing the most common member needs, you can shift your focus to more complex use cases. But small, quick wins to start will lead to more internal support for additional investments.
  2. Enable Proactivity – I once worked for a software company that was very reactive. They didn’t invest in account management, instead, reacting to issues as they arose. It lead to a much higher customer churn rate than had they proactively approached customers to understand their satisfaction levels. Many health insurers act like that software company. They react to members, instead of proactively directing members to resources, sending them specific information after certain procedures, analyzing their interactions, and prioritizing outreach to those that meet a churn risk profile. When shopping for technology, find technology that enables your member services organization to be proactive, not reactive. You want tools that make it easy for members to find information, but you also want tools that make it easy for your team to find members that may need outreach.
  3. Focus on the Individual Experience — Finally, one size does not fit all, especially when it comes to your members. They have unique demographics, unique needs, and unique temperaments. The more you can personalize the experience, the better. As a result, look to solutions that aren’t one-size-fits-all but instead enable you to personalize member experiences based on demographics, claims data, past interactions, etc.

Here are some solutions that can help you improve the health insurance member experience.


b.well offers health plans a platform that gamifies personalized health journeys. They also embed telemedicine as well as a provider search, mobile scheduling, and more in an application. The company’s apps are highly rated on both the Apple and Google stores. You can learn more at:


Castlight bills itself as a healthcare navigation company. What does that mean? They offer personalized experiences by ingesting data to understand member needs and the best action in the health journey. The company’s SmartMatch algorithms direct members to the highest quality, most cost-effective, healthcare providers. The company also offers a so-called “digital front door” that simplifies the member experience by providing one place for their health needs. Anthem (now Elevance) was an early investor in the company and Blue Cross Blue Shield of Minnesota recently announced a collaboration with Castlight. You can learn more at


Zipari offers several tools and solutions designed to improve the member experience. Their Service Center improves interactions with member service teams, the Service Bot is a conversational AI you can leverage to engage members, the Member Portal delivers on-demand access to important plan information, while the Mobile App delivers access to health plan information on their phone. Finally, the Engagement Hub improves a health plan’s ability to prioritize and automate member outreach. You can learn more at

Change Healthcare

Change Healthcare offers multiple solutions for health plans and providers. From a member engagement perspective, Change’s Smart Connect™ product leverages analytics — including claims data — to send members the right message at the right time.  Plus, a consumer engagement platform helps gain visibility into member touchpoints across your organization. The company’s Smart Appointment Scheduling™ helps schedule provider appointments and can send direct mail and digital reminders so they don’t miss an appointment. Learn more at


Icario bills itself as the health action company. What does that mean? The company combines demographic, clinical and consumer data to understand member needs. That results in a personalized experience. The company partnered with Blue Shield of California, where it helped increase high-value health actions by 300% and the program is expected to deliver $6 million in quality bonus payment value. You can learn more at


Wellframe offers what they call digital health management solutions. For example, the technology can prompt members to take virtual assessments, onboarding surveys, deliver personalized information and more. The company touts that it can increase member interactions while reducing inpatient admissions. You can learn more at


Shameless self-promotion aside, one of the most commonly overlooked member touchpoints is the billing experience. You have a monthly opportunity to provide a great experience. Yet most health insurers cobble together very manual, very archaic processes and technologies that lead to a poor member experience. Certifi automates the premium billing process, incorporating tools like a payment portal and configurable, rules-based delinquency management that not only delivers a better user experience but saves your billing team time every billing cycle. You can learn more at

Certifi’s health insurance premium billing and payment solutions help healthcare payers improve member satisfaction while reducing administrative costs.


Member Engagement - A Health Insurer's Guide

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