Data Governance Drives Informed Choices at Top Health Insurer

Client:

A prominent health insurance provider 

Challenge:

Our client, being a major health insurance provider, relies heavily on accurate and comprehensive data to effectively manage its operations. They needed a centralized repository for financial data sourced from operational Books of Record (BoR). Their BoR encompass a wide range of essential information, including policyholder details, claims processing, premium collections, and financial transactions.  

The objective was to establish a robust data ecosystem capable of supporting critical functions unique to their industry. These functions included: 

• Accounting: Our client’s financial health depends on accurate accounting records derived from their operational Books of Record. Ensuring that revenue, expenses, and financial statements are precisely documented and reported is vital for fiscal stability and regulatory compliance. 
• Regulatory Reporting: The healthcare and insurance sectors are subject to stringent regulations and reporting requirements. Accurate and timely data from operational Books of Record is crucial to meet these regulatory obligations and demonstrate compliance. 
• Enterprise-Level Business Analysis: Our client relies on comprehensive data analysis to make informed decisions, optimize processes, and enhance customer experiences. The data derived from these Books of Record serves as the foundation for enterprise-level business analysis, guiding strategic initiatives and improvements. 

This ambitious project presented multiple challenges in the realms of data governance, data quality, and metadata management. 

Key Challenges: 

• Data Governance: Our client lacked a comprehensive data governance framework to define data ownership, stewardship, and accountability. This resulted in inconsistencies and inaccuracies within their financial data, potentially leading to compliance issues and erroneous reporting. 
• Data Quality: Data collected from operational sources often exhibited quality issues, such as duplication, inconsistency, and incompleteness. These issues required resolution to ensure the reliability and trustworthiness of the data used for accounting and reporting purposes. 
• Metadata Management: As our client’s data ecosystem expanded, managing metadata, including data lineage and glossaries, became increasingly complex. Without an organized metadata management process, it was challenging to trace data sources and maintain a clear understanding of data definitions and relationships. 

Action:

To address these challenges, our client engaged the expertise of Prolifics, a leading provider of data management and analytics solutions. Prolifics implemented an end-to-end data governance solution, encompassing various facets of data governance, data quality, and metadata management. The project involved the following key actions: 

• Data Governance Charter and Vision Statement: Prolifics worked with our client to create clear objectives, principles, and goals for their data governance initiative. 
• Data Lifecycle Management: Prolifics helped establish rules for handling data from start to finish, ensuring it’s collected, stored, and used correctly according to regulations. 
• Data Governance Framework Adoption: Prolifics made sure everyone in the organization understood and agreed to the data governance framework, aligning it with business goals. 
• Roles and Responsibilities: Prolifics set up clear roles for managing data at each stage of its life, making sure everyone knew what they were responsible for. This involved defining roles for data stewards responsible for ensuring data quality and accuracy. 
• Business Glossary & Stewardship: Prolifics created a shared glossary of terms and processes to standardize data language and understanding. 
• End-to-End Data Lineage: Prolifics mapped how data moves within the organization, making it clear where it comes from and where it goes. 
• Data Quality Checks: Prolifics introduced checks to ensure data quality and created workflows for fixing issues, making data more reliable. 
• Metadata Management: Prolifics established a system to organize and manage metadata effectively. 

Results:

The successful collaboration in implementing this comprehensive data governance solution has positioned our client to effectively manage its financial data, ensure compliance with regulations, and make informed business decisions based on high-quality data.  

The implementation of the comprehensive data governance solution yielded several positive outcomes for our client: 

• Enhanced Data Governance – Better Data Control: Clear rules were in place for taking care of their data, which clarified responsibilities and made data management more efficient. 
• Improved Data Quality – Cleaner Data: The implementation of data quality checks and workflows significantly reduced data quality issues, increasing the reliability of financial data. 
• Effective Metadata Management – Organized Data: Data was now properly organized and labeled, simplifying data discovery and comprehension for everyone. 
• Increased Efficiency: Standardized processes and roles streamlined data management, reducing the time and effort required for maintaining and reporting financial data. 

Technology:

The following technology stack was utilized to implement the data governance solution: 

IBM Infosphere Stack: Prolifics harnessed the IBM Infosphere stack to deploy various components of the solution, encompassing data governance, data quality, and metadata management. The IBM InfoSphere stack (IBM Watson Knowledge Catalog) is a suite of software products and tools used for managing and governing data and encompasses a wide range of data-related functionalities and capabilities, including data integration, data quality, data governance, and metadata management. 

About Prolifics’ Data Governance Solutions

Prolifics empowers your organization with comprehensive Data Governance services, ensuring data quality, accessibility, and security. Our proven framework enhances decision-making, regulatory compliance, customer satisfaction, and risk management. With prebuilt, platform-agnostic processes, we optimize your existing investments while embracing new ones. Partner with Prolifics to unlock the full potential of your data and gain a competitive edge through our customer-focused approach to data governance. 

Curious to see how data governance can benefit your organization? Let’s chat! Click here to connect with our Data Governance experts and discover how we can help you drive better results with data governance. 

 

About Prolifics

At Prolifics, the work we do with our clients matters. Whether it’s literally keeping the lights on for thousands of families, improving access to medical care, helping prevent worldwide fraud or protecting the integrity and speed of supply chains, innovation and automation are significant parts of our culture.  While our competitors are throwing more bodies at a project, we are applying automation to manage costs, reduce errors and deliver your results faster. 

Let’s accelerate your transformation journeys throughout the digital environment – Data & AI, Integration & Applications, Business Automation, DevXOps, Test Automation, and Cybersecurity. We treat our digital deliverables like a customized product – using agile practices to deliver immediate and ongoing increases in value.  Visit prolifics.com to learn more. 

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