Canada
Puerto Rico
USA
Belgium
France
UK
India
Client Background
The client is an independently owned third-party administrator firm, supporting a wide variety of group benefit plans and a consultant in the healthcare and wellness marketplace. The client wanted to enhance their existing systems and build new solutions to streamline operations.
Client Need
A single solution to process member enrollment and claim files from multiple trading partners
A multi-tenant administrative system for customers (insurance companies and employers)
Mobile application for members to track qualification and other services that makes the member compliant
Solution for members to fulfil their pharma and emergency care needs
Push notifications to members based on services subscription
Solution
Built a core administrative platform for employers to manage their employee’s information and health plans to process eligibility, claims and agent commission information
Developed mobile application which tracks various qualified services, Telemedicine, Online Health Program for members/ employees and designed customized programs based on individual needs
Recommended and implemented features like Geo-fencing (Google API to find nearest pharmacies), notifying members when they are near to any emergency care
Built a mapper to parse and map enrollment and claim data from various trading partners in different formats (EDI, csv, excel etc.)
Realized Benefits
Reduced cost of infrastructure-setup which resulted in increase of profits by 12%
Employees qualified services enrollment ratio increased around 25% to 30% and satisfaction levels to 8.4 from 7.2 on a scale of 10
Features like Telemedicine and Geo-fencing led to strong connections with members and reduced hospital admissions to 10%
Made client systems robust and supports 5 message formats and standards
Tools & Technologies
Microsoft SQL Server
Xamarin
Azure Comos DB
Angular JS
Microsoft .NET
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