Digital enabled Health plan – Administrator for self-insured groups providing specialized services that required real – time point of service interactions across multiple channels. The client had dated legacy platforms and aging architecture which resulted in increase in overhead personnel and time spent on manual processes. The requirement was thus for rapid deployment of digital architecture to enable interactions to in house clinics, Pharmacy Benefit Managers as well as analytics solution
To create an integrated architecture to deliver point of service (POS) and adjust claims across multiple products.
• Provided a modernized core claims processing component
• Delivered a modernized core Platform (PaaS)
• Used a core integration component that supports real-time transactions across systems
• Received and processed accumulator data in real-time across medical and pharmacy products to calculate members’ out of pocket expenses
• Initiated the Javelina®-led agile development of client requirements
• Supported real-time submissions, adjudication decisions, and responses across multiple channels
• Developed support for real-time receipt of accumulators across multiple sources
• Established on-the-fly claims adjudication across multiple products
• Organized immediate POS response and request
Enhanced the process of claims automation
Improved client satisfaction and accuracy
Enabled growth and retention through the market differentiation feature
