Insurance Claims

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Customer is a US-based Third Party Administrator (TPA) for processing insurance claims. Business approach is to provide excellent service at a fair price without hidden charges. Customer stays abreast of changes in the workers' compensation system, which relates to the deep knowledge of:

  • most efficient medical providers;
  • most effective law firms;
  • most favorable judges; and
  • other considerations that may affect the cost of claims handling.

Interaction between employers, employees, and providers will optimize results for the Customer’s clients. Maintaining contacts with all concerned parties enables the Customer to head off problems that can lead to a sense of distrust by employees, which, in turn, may cause them to engage legal counsel. Customer’s goal is to protect their clients from misapplication and at the same time provide a service that treats each client’s employees as their own.

Customer’s original Claims Management System was developed in 1989 (operated by an IBM mainframe using an unnormalized database) as an administrative system for workers’ compensation claims for both self-insured groups and own risk entities. To increase the performance of the system, simplify the operators’ work, and streamline the document circulation, the Customer undertook the task to re-engineer the accounting system. Company turned to OMERTEX to build and implement a modern hardware-oriented web platform with industry-leading features, and retain all the legacy information when diligently following proper procedures for reporting, investigation, recording, and treatment of industrial injuries and diseases.

OVERVIEW

  • Services:
    • Business Analysis (BA)
    • Technical Analysis
    • Software Reengineering
    • Functionality Development
    • Quality Assurance (QA)
  • Metrics:
    • Effort: 3.500+ man-hours
    • Start: August 7, 2013
    • Status: ONGOING
    • Market: US
    • Industry: Insurance

CHALLENGE

  • Significantly increase productivity within the content management lifecycle through reengineering.
  • Effectively operate large amount of valuable financial information, e.g. checks, bills, claims, etc.
  • Provide access to informative reporting across the system database entities.

SOLUTION

As a base point of the new platform, OMERTEX chose the market leading ASP.NET MVC for its ability to scale to both business and technology demands developing custom web pages, components, and workflows. Implementing the new object model, normalizing the tables and migration of legacy data was a significant focus of the overall effort. The product was developed under strict guidance of internal practices including Continuous Integration and Release Management.

OUTCOME

New deployed system was thoughtfully designed to provide an industry-leading user experience (UX). By partnering with OMERTEX, the Customer was able to:

  • Execute a new robust solution with a scalable architecture.
  • Use a rich transactional functionality that supports online managing of accounts, claims, and bills.
  • Utilize powerful yet simple data creation and editing capabilities.
  • Preserve and simplify the access to the company legacy information.
  • Increase ROI through enhancing internal processes and practices.

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