See how Agentforce Health is cutting paperwork to make care more human.
Read nowImprove outcomes, contain costs with Salesforce for Payers.
Drive growth and retention while containing costs with AI-powered workflows that automate administrative tasks and free your teams to focus on member outcomes. Unite member, provider, and broker data with apps and AI agents to boost productivity and deliver personalized experiences at scale.
Leading payers trust Salesforce to optimize operations and improve member experiences.
Improve the member and provider experience while containing costs.
Scale contact center experiences.
Increase satisfaction and retention with a unified member experience.
Empower service teams with the right tools for success. Improve productivity with instant claims histories and status, as well as 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.
Strengthen provider networks.
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.
Give providers intuitive, easy-to-use portals, so they can see the status of their applications and conveniently manage profiles, issues, and care processes, leaving you time to focus on a better provider experience and delivering higher provider engagement.
Promote integrated care management.
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.
Access member health data from multiple sources to see claims, labs, pharmacy, EHRs, assessments, and social determinants to drive member health and risk insights.
Calculate unified health scores, identify at-risk members and enroll them in care programs to address their needs, improve adherence, and minimize risk. Use automated suggestions on assessment responses to expedite communication.
Streamline digital insurance sales and administration.
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 purchase.
Modernize utilization management.
Speed time to care with electronic intake, review, and tracking of prior authorizations and concurrent or retrospective 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 that enable 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.
Integration, Interoperability, and the Future of Healthcare
Build your payer solution with the following Salesforce products:
Health Cloud
Connect data and teams, automate processes, and personalize engagement on a single, intelligent platform to improve outcomes.
Data 360
Empower teams to engage customers at every touchpoint, with relevant health insights and contextual data in the flow of work.
MuleSoft
Integrate data from any system and automate complex tasks to deliver connected customer experiences, faster.
Agentforce
Create customizable, predictive, and generative AI experiences to fit all your business needs safely.
Analytics
Help your entire team find important answers and start making data-driven decisions.
Marketing Cloud
Personalize customer experiences and optimize each campaign with data-first enterprise solutions for any channel and device.
Sales Cloud
Grow your health business with enhanced productivity, intelligent sales, and streamlined forecasting.
Learn new skills with free, guided learning on Trailhead.
Keep up with the latest payer trends, insights, and conversations.
Webinar
Unlock Business Value with MuleSoft, Data 360, and Agentforce 360 for Healthcare Payers
Guide
Adopting Agentforce 360 for Healthcare
Whitepaper
Scale Member-Centric Care with Artificial Intelligence
Blog
Breaking the Bottleneck: How Healthcare Payers Are Streamlining Prior Authorizations
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Healthcare Payer Software FAQs
Healthcare payer software is a digital platform used by health insurance companies. It manages administrative tasks, member data, and provider networks. These tools streamline daily operations and improve service delivery. Modern systems, like Health Cloud, use AI to automate complex workflows and contain operational costs.
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.