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Cases & Expertise

Insurance platform

The ACA creates new competitive private health insurance markets that provide people and small businesses ability to select and enrol in high quality, affordable private health plans at competitive prices directly or through Independent Agents, TPAs/Brokers. End-customer was the main focus in the past and stay it in the present in terms of service as well as Independent Agents, TPAs and Brokers become the front-Client in terms of revenue generation relationships on Insurance market.

Our Client requests brand-new multi-tenant insurance platform with the main goal to support the whole insurance ecosystem. SaaS solution allows Insureds, Carriers, Agents, Brokers, CSRs and Exchanges to manage next things depending on role in the system:
• demographic data
• products, coverages and plans
• enrollments and policies
• claims
• billing accounts and payments

Platform is a core subsystem of the solution, and is a single point of integration for business-critical components. Besides that, Platform establishes shared business-operations services: CRM, Fee & Distributions management, Operational Reports (e.g. Policy Sales Activity Reports, Policy Transaction Activity Reports), Knowledge management, Billing Calendar, Schedules, Reports/Templates management.
Policy management simplifies Policy lifecycle management with easy-to-use solution for Quotation/Policy Processing and Collecting, Premium calculating, Premium Prorating in Case of Mid-Term Change, Binder payments as well as Policy Termination, Cencellation and renewal management.
Claims management automates Claim data collecting, Reserves and Financial Management processes.
Billing subsystem enables the Customer Service staff as well as Agents, TPAs, CSRs to resolve billing issues quickly and accurately. Billing rules can be created specifically for each product and Client can design billing plans and processes, such as predefined delinquency actions, minimizing uncollected earned premium exposure and write offs.
Ratings is the most complex subsystem mentioned to calculate Insured scores and evaluate risks for each Policy of the particular Customer.
Exchanges lets HIX-players to stay involved into the information exchange processes according to Government regulation and Industry standards: security, data transport, information safeguards management.



Value


up to 8% efficiency for HIX data processing up to 11% efficiency for Quotation/Policy management up to 17% efficiency for Repair Claim and Claim Settlement processes

Features


Customer self-service portal: Products, Coverages and Health plans, Billing Account management and Balance Tracking Broker/TPA and Insurer BPOs: Demographics & Enrollment, Renewal, Refunds, Cancellation and Terminations processing, Payments, Claims processing Billing: Installment Schedule Calculation, Invoicing, Clearing & Revenue management Ratings: Rates & Scores engine Exchanges: HIPAA 820/834 data processinng: Enrolment, Acknowledgement, Payment etc. Platform & Configurations: CRM, Fees & Comissions, Analytics, Reporting, Knowledge management, SetUps, Mappings, Schedules

technologies


Requirements / Use cases / Prototyping Java EE/Spring React.js / JavaScript Android/Java SE iOS/Objective-C PostgreSQL Mule ESB Reddis Private cloud
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