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Case Study

Reduced cost of infrastructure-setup for an independently owned third-party administrator firm and increased profits by 12%

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
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