Canada
Puerto Rico
USA
Belgium
France
UK
India
Client Background
Our client is a leading health insurance company in the US.
Client Need
Our client sought to modernize enrollment systems to process on-exchange and off-exchange applications from various channels. Key challenges included:
Managing a high volume of enrollment applications that need validation
Automating member management, application processing, and ID generation
Integrating third-party systems to accelerate policy fulfillment and ID card issuance
Solution
We implemented a comprehensive suite of solutions to streamline application processing, optimize member management, and ensure strong data validation and integration. Key solutions included:
Streamlined Application Processing: Built a pre-enrollment orchestration process to eliminate duplicates, identify application types, and implement multi-threading for high-volume CMS processing
Intelligent Member Management: Developed a 5-rule matching logic accommodating U65/O65 data for accurate member identification and automated ID generation
Comprehensive Validation & Integration: Designed a configurable business rule engine with 120+ validation rules and enhanced integrations with third-party systems via FTP through IBM Content Collector
Realized Benefits
Implementing this solution yielded significant benefits, including:
Successfully managed peak application volumes, processing 10,000 applications in 90 seconds
Streamlined enrollment and eliminated duplicate applications, resulting in a 2-5% inventory decrease
Decreased match exceptions from 15% to 3%
Reduced manual effort by 81%, from 21 to 4 man-days
Lowered rule exceptions from 14% to 4% through a configurable business rule engine
Tripled application processing speed from 6,000 to 18,000 applications per hour
Tools & Technologies
Entity Framework
AngularJS
JQuery
ASP.NET MVC4
Bootstrap
IBM Db2
Java
Microsoft SQL Server
SQL Server Integration Services
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