One of the largest TPA health insurance services providers operating in the Asian Region saved 30% on operational costs annually by automating claims management process.
The business Challenge:
A well known Third Part Associate (TPA) offering services to both the insured and the insurer was losing revenues due to complex claims management system they had. Company wanted to automate the entire claims process to reduce errors and keep a check on fraudulent claims. Since, it was a well know company and a TPA, company had tie-ups with all major health insurance companies in the region and had thousands of claims to be processed each month. The challenge was to develop a web based application that is scalable, can be accessed offline, capable of processing large volumes of data, can interact with other applications and exchange data and self optimizing for greater efficiency.
ADVANTON Inc. started the engagement with the client by analyzing the company’s existing applications and claims process they had in order to gain deeper understanding of their business processes. Our project team had several discussions with the company’s claims department and IT department in order to understand the requirements better and analyze the existing gaps in the existing applications they had.
A web based application in ASP.NET and SQL server 2005 was developed that was capable of processing high volumes of data from various sources such as insurance companies, agents and policy holders. The new application allowed policy holders and agents to login into the system and initiate their claims process directly. On the Admin side application allowed the company’s claims department to have access to all the information updated by the agents and the policy holders as well as edit, update, mark, flag, processes and close the case as needed. A desktop client was also developed using C# in order to enable offline access to the application in case of network failure or no internet access. The application interacted with several insurance companies’ databases through APIs and exchanged high volumes of data and was capable of matching records to prevent fraudulent claims.
Company was able to process claims quickly without errors. Company was also able to prevent fraudulent claims and saved revenues. The entire claims process became centralized and it not only helped the TPA but the associated insurance companies as well.
In the second phase of the project, ADVANTON Inc. enabled the company by implementing a documents management system to reduce paper work and annual stationary costs by 30%.
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