Client Background
The client is an independently owned third-party administrator firm, supporting a wide variety of group benefit plans and a consultant in the healthcare and wellness marketplace. The client wanted to enhance their existing systems and build new solutions to streamline operations.
Client Need
- A single solution to process member enrollment and claim files from multiple trading partners
- A multi-tenant administrative system for customers (insurance companies and employers)
- Mobile application for members to track qualification and other services that makes the member compliant
- Solution for members to fulfil their pharma and emergency care needs
- Push notifications to members based on services subscription
Our Solution
- Built a core administrative platform for employers to manage their employee’s information and health plans to process eligibility, claims and agent commission information
- Developed mobile application which tracks various qualified services, Telemedicine, Online Health Program for members/ employees and designed customized programs based on individual needs
- Recommended and implemented features like Geo-fencing (Google API to find nearest pharmacies), notifying members when they are near to any emergency care
- Built a mapper to parse and map enrollment and claim data from various trading partners in different formats (EDI, csv, excel etc.)
Tools & Technologies
Microsoft SQL Server, Xamarin, Azure Comos DB, Angular JS, Microsoft .NET
Key Benefits
- Reduced cost of infrastructure-setup which resulted in increase of profits by 12%
- Employees qualified services enrollment ratio increased around 25% to 30% and satisfaction levels to 8.4 from 7.2 on a scale of 10
- Features like Telemedicine and Geo-fencing led to strong connections with members and reduced hospital admissions to 10%
- Made client systems robust and supports 5 message formats and standards
