Modernizing Insurance: Tailored Billing and Seamless Integration for Employer Groups 

Client:

Our client is a publicly traded holding company with seven insurance subsidiaries offering diverse insurance products to working-class families and senior citizens. 

Challenge:

The client’s division tasked with providing health and life insurance to small employer groups encountered complexities when updating billing details due to life events, such as getting married or having a baby. The former method of handling customized billing details and schedules heavily relied on IT teams and manual processes, primarily involving Excel. This approach was inefficient and susceptible to errors. Consequently, the objective was to enhance efficiency, automate, and ensure accuracy in the process. 

They required a highly customizable ‘self-serve’ user interface (UI) that didn’t necessitate IT involvement. This included configuring new ‘output layouts and formats’ for new clients, modifying existing layouts, creating new data fields by combining existing ones or applying masking, setting up schedules, and configuring delivery methods like MQ, FTP, JSON, and XML, all without requiring IT intervention. 

Having previously collaborated with Prolifics, our client was familiar with the Prolifics-created platform designed for electronic data interchange (EDI) tasks (handled claims, payments, and enrollments and managed commissions for agents). Aware of its capabilities, our client wanted to repurpose this solution to automate their billing process. More with this client Faster Claims, More Control A Victory For Insurer And Patients | Prolifics US 

Action:  

After understanding the client’s unique billing format, data needs, and scheduling requirements, a solution was designed leveraging the Prolifics-developed platform. This platform, previously successful in managing claims and payments, was repurposed to cater to the client’s specific billing demands. The User Experience (UX) was a priority, resulting in mock screens that favored business professionals. The client’s requirement of processing data from Oracle, fine-tuning in Excel, and transitioning it to different formats was met, ensuring versatile data delivery methods, with encryption added for extra security.  

Results: 

The solution dramatically enhanced efficiency and accuracy: 

• Automation: Transformed manual processes into streamlined digital workflows. 
• Empowerment: Enabled business users to manage tasks independently of IT teams. 
• Cost Efficiency: Utilized contemporary software for financial prudence. 
• Visibility: Offered an instant audit trail for monitoring and tracking. 
• Flexibility: Provided scheduling capabilities like tasks set for specific days. 
• User Experience: Introduced a streamlined dashboard with error detection and immediate correction. 

Technology 

The project not only met but exceeded the client’s aspirations, demonstrating the transformative power of technology when aligned with business needs. 

The solution capitalized on the versatility of Python – a flexible, open-source programming language– ensuring minimal reliance on external software. The design is scalable, laying the groundwork for future Machine Learning and Artificial Intelligence integrations. Furthermore, the solution’s containerized nature guarantees flexibility in deployment, be it on-premises, cloud-based, or hybrid environments. Notably, Python’s capabilities enabled the creation of various data formats, making it a foundational and transformative element of the solution. 

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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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