Electronic Claims and Assessment Management System

Centric designs and builds a rich portal, transforming a previously paper-driven process into a system of improved document management, workflow and external data integration.

The Business Need

A large government insurance association needed to replace their current claims processing and management system, which supports the claim submission, processing, reconciliation and audit functions of their claims business. The client wanted to achieve the following:

  • Improve processing efficiencies and automation
  • Enhance auditing/reporting/analytics functionality
  • Allow ability to extend certain capabilities to member users via a secure channel on the Internet

Via an externally managed RFP process, Centric was selected as the systems integrator to design, build and support a new claims and member management platform. Centric was chosen because of its extensive insurance industry experience and the proposed “buy and extend” approach over a 100 percent custom build effort.

Centric’s High-Impact Approach

The scope of the project was quite broad and included the design and implementation of 35 business processes, more than 30 reports, several integration methods for external systems and users, and security for more than 30 defined user roles. Specifically, the project team completed the following:

  • Selected, sized and installed the hardware
  • Selected the hosting data center and negotiated the operational contract
  • Identified all business processes and implemented via selected technologies
  • Designed and implemented the system data model
  • Deployed advanced reporting and analytics

Centric utilized an agile design process to iteratively deliver functionality. Business processes were grouped into four major categories:  user administration, claims administration, document management and assessments. All business processes went through an iterative “playback” process where users were able to review requirements, wireframes and working functionality in separate review sessions. Each playback resulted in a refinement of functionality and system design.

The solution’s foundation is Microsoft’s SharePoint, which provides core document management and portal server functions. Lombardi’s TeamWorks Business Process Management engine provides workflow functionality and KnowledgeLake’s document management and indexing tool extends SharePoint’s native document management functionality.

All system functionality is presented via a personalized landing page based on the appropriate security authorization. The landing page contains access points into all key system functionality and quick access to personalized tasks.

The Results

With this portal, the association now fully manages its claims and assessment information electronically, enabling users and members to effectively and accurately handle claims processing.

This portal also supports a partner exchange, allowing companies to submit, query and interact with information in the portal through a service interface. These integrations leverage the ACCRD framework.

Finally, with this portal the association has been able to improve processing cycles, shrink payment cycle time and better manage data and information.