Improving Customer Service in Healthcare

---

Exceptional customer service isn’t just a nice-to-have in healthcare and insurance—it’s what keeps members trusting your organisation. With customer demands growing, insurers and administrators need smarter ways to track calls, manage responses, and maintain service quality. That’s where Smartchoice Technology comes in. As the authorised partner of PLEXIS Healthcare Systems, we provide advanced Call Tracking and Customer Service Business Applications—helping healthcare insurers deliver seamless, efficient support across every channel.




Why Customer Service in Healthcare Matters More Than Ever

In today’s healthcare landscape, member expectations are higher than ever. Whether through call centres, self-service portals, or digital platforms, organisations must deliver:



• Quick, accurate responses – No one should wait days for a simple answer.
• Seamless multi-channel support for a consistent customer experience.
• Automated tracking and resolution workflows to enhance efficiency
• Data-driven insights for continuous improvement and regulatory compliance.

Without an integrated system, healthcare funders and TPAs face delays, inefficiencies, and frustrated members. That’s where Smartchoice Technology, powered by PLEXIS, steps in—bridging the gap between expectation and delivery.




Key Features of Smartchoice-Enabled PLEXIS Call Tracking & Customer Service Business Apps

Centralised Call Tracking & Member Management

PLEXIS’ tools capture every interaction—calls, emails, chats, or portal queries—in one unified platform, ensuring nothing slips through the cracks. Benefits include:



• Complete visibility - All enquiries logged and categorised for easy tracking.
• Smart workflow routing – Automatically directs issues to the right team for faster resolution
• First-call resolution (FCR) boost – Agents get instant access to member history, claims status, and policy details.
• Real-time dashboards – Supervisors monitor call volumes, agent performance, and compliance with SLAs.



Seamless Multi-Channel Member Engagement

Members engage across multiple touchpoints. PLEXIS and Smartchoice ensure consistency, whether they contact you via:



Call Centres: Intelligent call routing, queue management, and real-time integration with PLEXIS Quantum Choice™ and Canopy™ Care Management.

Email & Digital Portals: Member inquiries are captured and routed via automated email tracking and online support portals.

Walk-in Centers & TPA Helpdesks: Front-desk agents can instantly access claims data, provider directories, and appointment scheduling systems to resolve inquiries on the spot.




Automated SLA Compliance & Quality Control

Staying compliant while maintaining high service levels is non-negotiable. PLEXIS includes built-in safeguards:



• Custom performance metrics to track response times, resolution rates, and member satisfaction.
• Automated SLA monitoring that alerts teams when inquiries approach escalation thresholds.
• Audit-ready interaction logs for HIPAA, ICD-10, and regulatory compliance reporting

These features help healthcare payers, TPAs, and insurers maintain high service quality while reducing compliance risks.




“Customer engagement in healthcare isn’t just about answering questions—it’s about giving members clarity, confidence, and seamless support throughout their journey”

Smartchoice Technology




Advanced Integration with Core Administrative Systems

One of the biggest advantages of the Smartchoice-PLEXIS partnership is the seamless integration of customer service tools with core healthcare administration systems, such as:

• PLEXIS Quantum Choice™: Instantly access claims adjudication, premium billing, and member eligibility information within call-tracking workflows.
• PLEXIS Canopy™ Care Management: Improve care coordination by linking member inquiries to ongoing care plans, case management, and patient engagement tools.
• CRM & Telephony Integration: API-driven architecture allows for real-time connectivity with platforms like Salesforce, Microsoft Dynamics, and secure VoIP systems.

These integrations eliminate data silos, allowing customer service teams to make informed, real-time decisions based on a complete member profile.




Scalable, High-Performance Support for Large-Volume Environments

Whether managing a regional TPA or a large health plan with millions of members, PLEXIS solutions scale effortlessly to handle high transaction volumes and complex service requirements, thanks to:

• Cloud-based and on-premises deployment options for flexibility.
• Robust security and compliance features to protect member data.
• Predictive analytics and AI-powered insights for continuous service optimization.

This scalability ensures that Smartchoice Technology and PLEXIS platforms can support both small enterprises and national healthcare networks.




Why Leading Healthcare Providers Choose Smartchoice Technology & PLEXIS

As demands grow, medical schemes need more than basic call-tracking software. With Smartchoice Technology as the authorised agent of PLEXIS Healthcare Systems, you get:

• Smarter automation – Cutting wait times and speeding up resolutions.
• Full ecosystem integration – Unifying customer service with claims, care management, and admin systems.
• Future-proof scalability – Adapting seamlessly as your needs evolve.



Elevating Customer Service in Healthcare

Smartchoice Technology, as the authorised agent of PLEXIS Healthcare Systems, provides a comprehensive customer service solution that enhances customer engagement, streamlines operations, and ensures seamless communication between members, providers, and administrators.




By integrating PLEXIS Quantum Choice™ and Canopy™ Care Management, we empower healthcare organisations to deliver fast, accurate, and high-quality customer support—setting a new standard for healthcare customer service excellence.




Ready to optimise your customer service operations?

Let Smartchoice Technology and PLEXIS help you transform healthcare engagement today.