Medicare Brokers: The Two Most Critical Automated Workflows You’re Not Using

Medicare Brokers: The Two Most Critical Automated Workflows You’re Not Using

Medicare Brokers: The Two Most Critical Automated Workflows You’re Not Using

Zack Lewis : November 3 2020

“If you focus on the goal and not the process, you inevitably compromise.” – Yvon Chouinard, Founder of Patagonia


Everything we do in our day-to-day lives is a process, and whether we achieve the optimal outcome from the energy invested directly relates to the effectiveness of the process we use to approach it.

On that basis, we can say that extracting the greatest amount of profit from the efforts of your entire team will boil down to the process they follow for selling and submitting Medicare policies.

Over the last 10 years, StackBoost.io engineers have had the opportunity to work with some incredible Medicare Brokerage Owners to assess, redesign and implement both systems and processes for achieving optimal production – these ideal workflows stem from our experiences and have proven to work consistently over time.


Important Information:


It’s critical to note that these ideal workflows are designed to function inside a CRM or other Brokerage Management Systems (BMS) for optimal results, including 10x your sales production and operational turn-times. Processes driven and enforced through the use of business management platforms allow Brokerage Owners to integrate sales, operational, and Executive departments to automate away most redundant tasks that take employees off course from their core responsibilities.


What is a Workflow?


Workflows are made up of Statuses and Transitions.

status represents the current business state of a given object or “ticket”.

An object could be a lead, policy, customer, etc. and a corresponding status could indicate a Prospect as a “New Lead” or “Callback”, or a Policy being “Paid” as an example.

Transitions represent the paths that can be taken between statuses; they allow us to determine the flow of activity that needs to take place, implement checks and balances, or trigger automated behavior in response to a status change.

For example, a customer visits your website and fills out a short form to get more information. When that lead is received by your system, it could automatically create a new ticket and apply the status of “new lead” that directs the system to take the next steps in your workflow.

If an agent attempts to contact that lead and they do not answer, a transition to the status “No Contact” would be appropriate.


Automation and Workflows


In the previous example where an agent attempted to reach a prospect and they didn’t answer, an ideal workflow will automatically perform that transition to change the status to “No Contact”.

Automated workflows are the keystone of an efficient business process. When combined with a strong business management tool, you can exponentially enhance the execution efficiency of your processes at a rate impossible to achieve by hand to produce consistent, predictable, and measurable outcomes.


Lead Management Workflow



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Robust, effective, and easily understood by our floor agents. We transform a highly complex process with intricate steps into something simple and broadly driven by automation, leaving agents with minimal responsibilities beyond having sales conversations with quality prospects.


Statuses and Meanings:


  • New Lead – Untouched, brand new lead. Fresh out of the oven.
  • No Contact – Unsuccessful at reaching the lead yet.
  • Callback – A scheduled appointment or callback time has been set.
  • No Sale – This lead has been closed and is not to be contacted any further.
  • Sale – Our favorite kind of lead.

Agent Responsibilities:

  1. When contact is made, transition the status based on the outcome of the call (i.e. “Sale”, “Callback”, etc.)
  2. When a Sale is made, enter all required fields needed for policy submission.


Automation Responsibilities:

  1. Alert prospect via text when an agent is about to contact them, the number they are calling from, and the reason for the call.
  2. Appointment and callback reminders automatically sent for prospects.
  3. Live lead distribution to sales agents in real-time based on business rules:
    1. Including States the Agent is licensed in;
    2. Current conversion rate of the Agent;
    3. Number of leads current assigned to the Agent.
  4. Loading leads into the CRM in real-time daily based on scheduling priority
    1. Optional: Load into dialer software automatically for agents daily.
  5. Prioritizing leads based on Status and other criteria:
    1. Date the lead was created;
    2. The number of contact attempted for the lead;
    3. The specific lead Source (i.e. Google, Facebook, IMO, purchased data, etc.)
    4. Open Enrollment Eligibility.
  6. Close lead tickets as “Exhausted” by transitioning status to “No Sale” after a defined number of contact attempts.
  7. Regular SMS communications to “No Contact” leads as part of the follow-up sequence.
  8. Automated reminders for agents 30 minutes and 15 minutes before any scheduled callback.
  9. Alerts via Slack or text to agents when they receive new leads to contact.


*Note the number of responsibilities for your Agents vs the System. This type of delegation ensures more time for your sales team to be at their highest and best – closing deals.


Back-end Policy Management


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Sales get the paperwork signed, operations gets you paid. These two departments should not be treated as separate entities but rather one unit with a unified purpose. When the system connects both departments, the result is harmonious profitability.

Operational responsibilities within a Medicare Insurance Brokerage are unique relative to other businesses. They include a high volume of intricate parts that when done incorrectly can cause confusion, chaos, and frustration.

Process cures chaos.

Statuses and Meanings:

  • Awaiting Processing – A new deal has been submitted by an agent and needs to be verified by the Carrier.
  • Hold – Policy needs to be held for a reason outside the workflow.
  • Approved – Policy is Approved and Issued by the Carrier.
  • Awaiting Payment – Company has not yet received a commission from the Carrier.
  • Paid – Company has received commission payment from the Carrier.
  • Active – Policy is active and in good standing.
  • Followup: Bank Correction – There is an issue with the customer’s payment.
  • Followup: Canceled – The customer voluntarily canceled their policy.
  • Followup: Application Corrections Needed – There was an issue with their application when submitted to the Carrier.
  • Followup: Lapsed – The customer’s payment has lapsed.
  • Canceled / Withdrawn – the Customer has canceled their policy or it has otherwise become inactive.
  • Lapsed – The policy lapsed coverage and will not be pursued further.

Administrative Responsibility:

  1. Verify information submitted by Sales Agent.
  2. Update Policy status after an interaction with the Carrier or the Customer.
  3. Upload carrier documents to the ticket.

System Responsibilities and Transitions:

  1. Prioritize policies according to the pre-defined business rules for how staff attends to each ticket.
  2. Delegate actionable tickets to operations staff to resolve.
  3. Prioritize tickets according to:
    1. Status of the ticket;
    2. Last activity date of the ticket;
    3. Who the assigned Agent is for the file.
  4. Quality Control that all fields are correctly formatted prior to submission to the Carrier.
  5. Ensure the required fields are completed at the correct milestone in the workflow.
  6. Ensure tickets have the correct documents uploaded to them for Compliance.
  7. Create automated contact methods for any of the policies with “Followup” statuses:
    1. Send automated text message follow-ups;
    2. Automatically generate dial lists for operations staff to contact based on a file’s priority;
    3. Automated outreach by email, text, etc. for the policies in “Approval” status.
  8. New Policy submissions to Carrier
  9. Reconciliation of Carrier statements upon receipt.
  10. Text and email alerts for upcoming Effective Dates.
  11. Reminder Text and Email for Effective Dates and Contact Information.


*Note the number of responsibilities for your Administrative Staff vs the System. This type of delegation increases the number of sales your brokerage can close without having to increase payroll costs to facilitate the growth.



The building is only as tall as the foundation is strong enough to build on.


By integrating your sales and operational departments with a Brokerage Management System (BMS) equipped with automation functionality, you are laying the foundation for systematic growth.

Only through this type of integration can you implement clean and effective processes capable of guiding and enforcing your business rules automatically, measurably, and consistently over time.

These workflows are foundations designed to be expanded, improved, and iterated over time. We have personally been part of such transformations with Medicare Brokers like you who within only 6 months or less, increased sales by 1,236% while reducing the wasted time from manual tasks by over 500+ hours per month without having to hire a single additional employee to facilitate the growth.

For more valuable insights about Medicare technology, check out our blog at https://stackboost.dev/blog/

P.S. I started a LinkedIn group called “Success-With-Tech for Health Insurance Brokers” where you can ask tech questions and get answers from experts and other brokers experiences. If you’re considering buying some of these valuable tools to increase your flexibility and want some feedback before pulling the trigger, ask and ye shall receive.

The Best is Yet to Come…