See What’s New: Financial Services Cloud, Health Cloud, Life Sciences Cloud

Learning Objectives

After completing this unit, you’ll be able to:

• Describe the latest features and enhancements for Financial Services Cloud, Health Cloud, and Life Sciences Cloud.
  

Reimagine regulated engagement across Financial Services, Healthcare, and Life Sciences by combining automated workflows with high-touch, empathetic support. From 24/7 voice-assisted claims intake to hands-free field reporting and compliance guardrails for regulated events, these capabilities allow organizations to streamline administrative burdens while protecting sensitive constituent data.

Financial Services Cloud

Claims Service Customer Assistance

Automate insurance claims intake with a voice-enabled agent. Policyholders initiate First Notice of Loss via phone and other channels 24/7, with no customer service rep (CSR) required. The agent captures claim details, validates policy data, creates the claim and case record, and escalates to a CSR when needed. Data masking protects sensitive information. Cut costs, boost efficiency, and deliver a faster, guided claims experience.

Claims Financial Authority

Automate financial authority enforcement for claims payments. Every request is validated against the user's Letter of Authority, and anything above their limit is automatically routed to the right approver with a full digital audit trail. Admins configure authority matrices by role and claim type, with per-user limit customizations, so organizations maintain complete control over their financial governance posture.

Group Policy and Contract Servicing

Group contracts and associated individual member policies never stop changing. One unified engine handles every life event, amendment, and renewal and allows you to generate live census snapshots and enforce chronological integrity automatically. Mid-term adjustments that previously required hours of manual processing now execute in minutes, and anniversary renewals that consumed weeks of reconciliation now close automatically with guaranteed accuracy.

Health Cloud

Patient Access and Referral Management Enhancements

Providers can now submit referrals directly from their EHR and receive real-time status updates via bidirectional HL7 integration. Meanwhile, patients receive personalized outreach at every step. Care coordinators see leakage rates, referral conversion, and time-to-appointment metrics in embedded Tableau Next dashboards with an Analytics Agent, to explore trends on demand.

Payer Contact Center Enhancements

Reduce contact center rep handle time and improve resolution. Health Cloud equips payer contact center reps with AI-generated summaries, automated call wrap-up, and an agentic claims search agent.

• The moment a call begins, payer contact center teams now get an AI summary of any member or provider record—no need to navigate through related lists and records.
  
• A voice agent verifies callers and resolves basic claims, prior auth, and eligibility queries, and escalates complex calls to reps. The agent also automatically handles post-call tasks including case creation and engagement records.
  
• For provider claims inquiries, reps and claims teams can use natural language to search by NPI, claim number, prior auth number, status, and a combination of member ID and service duration to get instant access to claim denial reason, payment status, and processing errors, from Data 360.
  

Health Engagement Enhancements

Health Cloud gives payers embedded care gap analytics and an agentic formulary self-service experience that improves member outcomes and reduces contact center call volume.

With Winter ’27, payer organizations get two capabilities that close the engagement loop.

• The Care Gap Closure Dashboard that’s pre-loaded in the Health Engagement app gives leaders real-time metrics on closure rates, intervention frequency, and HEDIS and Stars performance, which they can filter by plan, condition, and geography.
  
• The Formulary Self-Service Agent lets members ask natural language questions like “Is Eliquis covered under my plan?” or “Is there a cheaper alternative to Jardiance?” and get instant, accurate, plan-specific answers on Experience Cloud, SMS, or WhatsApp, any time of day.
  

Life Sciences Cloud

Order Management

Turn every store visit into growth. Optimize pricing, streamline quotes and approvals, and capture e-signatures. Drive product adoption with live shelf visibility, availability tracking, photo audits, and data-backed actions.

Voice-Based Visit Logging

Simplify field reporting and keep your teams in sync with a voice-activated, hands-free reporting experience to quickly log key insights, objections, and questions from visits.

Events Management: Monetary Cap and Utilization Limits

Keep regulated event spending on track with configurable budget thresholds, utilization limits, and proactive controls that reduce compliance risk.