2400 Meadowbrook Parkway, Duluth, GA 30096 | +1 770-493-5588 Follow Us
Select Page

Case Study

Improved the enrollment process a leading health payer based out of US and removed duplicate applications for thereby reducing the inventory by 2-5%.

Client Background

The Client is a leading health payer based out of US. Client was using the legacy systems for on-exchange and off-exchange enrolments. Client wanted to modernize their existing systems to process applications from various channels including CMS, online sales, paper based, from agents and private exchanges.

Client Need

  • Build an enrollment system to accept and validate large volumes of applications
  • Assign an incoming enrollment application to existing members based on their availability and generate new member IDs
  • Validate large volume of enrollment applications at the rate of 10k per hour during the open enrollment period
  • Integrate with third party applications to generate policy fulfillment kits and improve the ID card generation rate to speed up the process

Our Solution

  • Built a pre-enrollment orchestration process to identify incoming application type and removes duplicates from processing
  • Implemented multithreading in Windows services to process large volumes of CMS applications
  • Implemented a member match logic with 5 sets of rules and a logic to accommodate U65 and O65 data in member match and member ID generation
  • Built a configurable business rule engine with 120+ member eligibility and application data validation rules from Federal, State and Payer sources
  • Implemented asynchronous communication to increase the application performance
  • Enhanced existing integrations with third-party systems (Silver pop, RR Donnelley, Fiserv, etc.) from a service call to FTP through IBM Content collector

Tools & Technologies

Microsoft.net entity framework, Angular JS, jquery, ASP.Net MVC4, Bootstrap, IBM DB2, Java, Microsoft SQL Server, SQL Server Integration Services

Key Benefits

  • Improved the enrollment process and removed duplicate applications, thereby reducing the inventory by 2-5%
  • Handled large volumes of applications without any issues and processed 10k applications in 1 min 30 sec
  • Reduction in match exception inventory from 15% to 3%
  • Reduced manual effort from 21 man-days to 4 man-days
  • Configurable business rule engine helped in reducing overall rule exceptions from 14% to 4%
  • Improved enrollment application processing speed from 6K to 18K in an hour
  • Increased fulfillment kit generation rate by 15%
  • Improved ID card generation rate from 80k per hour to 320k per hour
Case Study KeyPoints

Let's Connect

Talk to us and know how our over two decades of experience and a strong global presence can transform your business.

Services

Digital Product Engineering

Cloud Services

Data & Analytics

Intelligent Automation

Cyber Security

Build Operate Transfer

Talent Solutions

Industries

Communication & Media

Hi-Tech

Healthcare, Life Sciences,
and Insurance

Banking & Financial Services

Energy and Utilities

Retail

Manufacturing

Transportation and Logistics

Innovation @ Work

Blogs and Insights

Research and Whitepapers

Case Studies

Podcasts

Webinars & Tech Talks
US Employment Reports

Company

About Us

Leadership

Strategic Partnerships

Office Locations

News and Events

The Foundation

Careers

Open Positions

Life @ Innova Solutions

Candidate Resource Library

Let's Connect