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Healthcare and Life Sciences

Faster referrals & authorisations. Better patient & member experiences

Built on Salesforce. Streamlining care and service workflows - with automation, intelligent routing and AI where it adds value.

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Ortoo's Salesforce productivity apps enable Sales & Service teams to dramatically transform productivity and performance

Trusted by high-stakes HLS teams running Salesforce

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charlie health logo
defense health agency logo
novartis logo
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baptist health logo
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bamboo health logo
flatiron logo
molecular devices logo
account matching

EVEN WORKLOAD
DISTRIBUTION

dynamic assignment rules

THROUGHPUT
STABILIZED

channel management

END-TO-END
SALESFORCE CONTROL

READ THE CASE STUDY

Bring SLA Control to Complex HLS Operations

Healthcare and life sciences teams manage high volumes of inbound work across multiple systems and specialist teams, all under strict service and compliance expectations. Fragmented intake, incomplete requests and simplistic routing create delays, stalled handoffs and limited visibility into service-level risk.

Ortoo streamlines intake and assignment into structured, trackable work inside Salesforce, routing every item based on urgency, coverage models, working hours, and capacity. AI can be leveraged where it accelerates action, like auto-classification, completeness checks, and handoff supervision.

Standardize referral intake, validate key info, and route by service line, site, and urgency. Reduce admin overhead and improve access coordination.

Triage and assign prior auths, benefits checks, and determinations based on plan logic, specialist teams, and real-time capacity, all within SLA.

Support medical info requests, access programs, and device support with structured intake, consistent handoffs, and audit-ready tracking across global teams.
providers and healthcare services
novartis logo

Healthcare and Life Sciences in Action: Novartis

Novartis is an innovative medicines company. They run large-scale, regulated service operations where performance depends on getting the next request to the right team quickly, then keeping work moving through specialist pathways without stalls.

The Challenge

  • High case volumes with work stalling in queues during peak periods
  • Complex assignment variables including ZIP codes, territory coverage, account-based teams and time zones
  • Uneven workload distribution with limited capacity-based balancing
  • Manual reassignment when team members were out of office, creating delays and risk
  • Limited visibility for team leads into capacity, pending assignment and where work was building up

Result: Turnaround time and service levels were vulnerable to volume spikes, coverage breaks and inconsistent routing.

What good looks like

A regulated service operation where capacity is explicit, routing reflects real coverage models and leaders can see backlog risk early – including which teams are nearing capacity and which work is pending assignment.

The Impact

  • Capacity-based assignment so new work goes to the team member with the lowest active load within defined limits
  • Multiple assignment models supported in parallel, including ZIP and territory-based teams and account-based coverage teams
  • Round-robin and queue protection behaviour when teams reach capacity thresholds
  • Automated continuity during out-of-office and shift handoffs to prevent stalled work
  • Dashboards that surface capacity, backlog, pending assignment and early-warning indicators for leaders

Result: More consistent throughput, fairer workload distribution and stronger operational control.

Why it matters

When assignment reflects real capacity and coverage, work keeps moving during peak periods. Smart leaders shift from reactive firefighting to predictable, controlled service delivery.
account matching

EVEN WORKLOAD
DISTRIBUTION

dynamic assignment rules

THROUGHPUT
STABILIZED

channel management

END-TO-END
SALESFORCE CONTROL

This pattern repeats across healthcare and life sciences. When stakeholders are split and risk tolerance is low, performance improves when intake is complete, routing matches real-world coverage rules and leaders can manage capacity before service levels slip.

Where healthcare and life sciences operations break down

(and how to fix them)

1

Referrals, prior authorisation requests, benefits investigations, medical information enquiries, specialty pharmacy coordination and service tickets arrive in inconsistent formats, often with attachments and partial context. Teams waste time translating demand into something workable before they can take action.

Ortoo turns inbound demand into structured Salesforce work, capturing the fields your teams actually need so work starts clean and routes correctly.

Solution components: Multi-channel intake → Structured work creation → AI-powered Data capture and validation.

1

2

Authorisations bounce because documentation is incomplete. Benefits checks stall on missing coverage details. Medical information requests arrive without product and clinical context. Patient support and access workflows pause waiting on forms, identifiers, signatures or confirmations. Every loop adds delay, increases escalations and creates inconsistent service levels.

Ortoo checks what is missing early, routes “needs info” items appropriately, potentially calls on external LLM to retrieve missing information and prevents incomplete requests from interrupting specialist teams.

Solution components: Completeness checks →AI data completion →Required-field validation → Exception handling for “needs info” items

2

3

In this industry, “right team” depends on plan rules, line of business, territory, account coverage, prescriber or site of care, product, language, pathway and time zone. When routing is simplistic, utilisation management queues bloat, patient support teams get interrupted and cases land with the wrong specialists.

Ortoo assigns using coverage logic and operational constraints so work reaches the correct pathway, within the correct working hours, first time.

Solution components: Coverage-aware routing → Skills and priority-based assignment → Time zone-aware delivery

3

4

When distribution is accidental, a handful of case owners get overloaded while others have headroom. Prior authorisation cycle times become unpredictable, determinations slow, referrals drift and service desks swing between idle and overwhelmed. Volume spikes turn into backlogs because the system cannot balance capacity in real time.

Ortoo assigns the next request based on real capacity and current load, not static queues, protecting throughput and keeping service levels stable during peaks.

Solution components: Capacity-based assignment → Workload balancing → Round-robin and queue protection

4

5

Coverage breaks are where regulated operations quietly fail. Work stalls when someone goes out of office, when a shift ends or when a case escalates to a specialist reviewer. The operational risk is missed commitments, delayed responses and poor visibility into who owned what when.

Ortoo reassigns intelligently when coverage breaks, supervises escalation pathways and keeps every handoff traceable from intake to resolution.

Solution components: Out-of-office and coverage continuity rules → Automated reassignment → Escalation pathways with supervision

5

6

Teams often only notice trouble when the prior authorisation backlog is already high, member services queues are saturated, medical information response timelines are slipping or device support tickets are escalating. Without early signals, management becomes reactive and firefighting becomes normal.

Ortoo surfaces capacity, backlog and pending assignment in real time, then flags teams nearing thresholds so leaders can intervene early. Optional AI driven early alerts on risk.

Solution components: Capacity and backlog dashboards → Service-level supervision and alerts → AI-powered Early-warning indicators

6
ortoo apps for salesforce

AI Where It Adds Value, With Control

Ortoo uses AI to remove friction from healthcare workflows, without sacrificing control, compliance, or cost.

Classifies referrals, authorizations, and service requests in real time

Checks completeness before routing to reduce delays and loops.

Flags SLA risks and stalled handoffs before service levels slip

Selects the right AI model for each task, avoiding overuse of premium LLMs

Keeps every action traceable with human-in-the-loop supervision

salesforce logo

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Let’s Streamline your healthcare ops in Salesforce

If your HLS teams manage referrals, authorizations, medical info, access services, or diagnostics, Ortoo can help.

Start with structured intake. Add SLA-aware routing. Surface risk before it hits performance.
Scale with AI when you’re ready, without losing control.

Talk with an expert

See how Ortoo fits your operating model.
CONTACT US

Use Cases Across Healthcare and Life Sciences

CARE DELIVERY AND CARE FINANCING OPERATIONS

Discover the diverse application potential of Q-assign and Email-to-anything, with our Salesforce use cases

Referral intake and patient access coordination

Standardise referral intake, validate required details and route work to the correct pathway so patient access teams spend less time on triage and more time progressing patients. Support distributed coverage models across sites, service lines and working hours.
Discover the diverse application potential of Q-assign and Email-to-anything, with our Salesforce use cases

Prior authorisation, benefits investigation and documentation validation

Automate intake and completeness checks so submissions are processing-ready, exceptions are routed consistently and cycle time becomes predictable. Reduce “bounce backs” by preventing incomplete requests from reaching the wrong teams.
Discover the diverse application potential of Q-assign and Email-to-anything, with our Salesforce use cases

Utilisation management determinations, queues and escalations

Route utilisation management work by line of business, plan rules, urgency and capacity, then supervise progression through determinations and escalations so work does not stall in generic queues or sit pending assignment.
Discover the diverse application potential of Q-assign and Email-to-anything, with our Salesforce use cases

Appeals, grievances and service-level supervision

Maintain clear ownership across appeals workflows with controlled handoffs, supervised milestones and traceable histories. Give leaders real-time visibility into backlog, ageing and service-level risk across teams.

LIFE SCIENCES, MEDTECH AND DIAGNOSTICS OPERATIONS

Discover the diverse application potential of Q-assign and Email-to-anything, with our Salesforce use cases

Medical information request intake and routing

Capture HCP enquiries and medical information requests as structured work, route to the correct specialist group and keep response timelines visible and controlled with audit-ready histories.
Discover the diverse application potential of Q-assign and Email-to-anything, with our Salesforce use cases

Patient support programs and access services

Automate intake, triage and assignment across patient support operations including reimbursement services and coordination tasks. Balance workload across teams and maintain traceable handoffs as cases move through specialist pathways.
Discover the diverse application potential of Q-assign and Email-to-anything, with our Salesforce use cases

Product enquiries, account coverage and specialty pharmacy coordination

Support commercial and service teams with account-based coverage models, capacity-aware assignment and reliable handoffs across partner workflows, specialty pharmacy coordination and service operations.
Discover the diverse application potential of Q-assign and Email-to-anything, with our Salesforce use cases

Device and diagnostic service requests and complaint-style escalations

Route device and diagnostic support by product line, territory and entitlement context, manage escalations reliably and maintain the traceability required for regulated support operations, including complex handoffs between frontline and specialist teams.
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