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OUR CLIENT

Digital enabled Health plan – Administrator for self-insured groups with the need to interact in realtime with in-house clinics, Pharmacy Benefit Managers and date analytics solutions.

Objective: 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

Target Results

 

  • Enhanced the process of claims automation
  • Improved client satisfaction and accuracy
  • Enabled growth and retention through the market differentiation feature