Table of content

THE CLIENT OVERVIEW

Our client is one of the leading General Agencies in California, US. Our Client also acts as an agency that provides a bridge between the carriers and the brokers in offering Health Insurance to California. They offer information on plans, rates, carriers, eligibility requirements for enrollment. Quotes in easy to understand formats are given to brokers and groups.

The application developed handles all functionalities for Third Party Administrator for a wide range of carriers. Our client provides the pricing benefits of a large group pool using the quotes system developed. Quote engine was running in ASP technology and we converted it into a robust self-sustaining .Net application.

BUSINESS SITUATION AND XORIANT'S SOLUTION

The Xoriant development team was engaged in designing and implementing the Windows desktop based Administration modules that automate Operations and Finance workflow functions. The application automates tasks involved in enabling enrollment, termination, invoicing, renewals, accounting, disbursement, and reporting. Open enrollments are done using a Web based application.

  • Online Enrollment
  • Revamp of Quotes engine
  • Transmission

Xoriant used a blended delivery model that included on-site Xoriant project manager, on-site business analyst, offshore Xoriant developers and testers, and client team members. Xoriant leverages a cost-effective and efficient offshore delivery model.

Additionally, Xoriant has a full complement of subject matter experts on Business Intelligence (BI), Infrastructure, and Web Design whose skills that the development team taps in order to resolve any project specific challenges.

The Xoriant team, along with the client team, executed the project effectively using the Agile methodology. The Agile and Scrum processes have become recognized as some of the best project management frameworks for handling rapidly changing or evolving projects, especially those with technology or requirements uncertainty.

APPLICATION FLOW

Benefit Administration – Service offerings

Competency Area

Carrier / Vendors

HIPAA Compliant 834 Audit and Transaction files

Integrated with BlueShield of California, Health net, Kaiser Permanente, Humana, Delta Dental and VSP

Plan Customization / Benefit Design

BlueShield of California, Health net, Kaiser Permanente, Aetna and Delta Dental

Validate Plan Eligibility Rules

Health net and Delta Dental

Custom Fees and Charges

Delta Dental

Bank Integration

Wells Fargo, Benicentral, HSA , ACH

Mail-house and Bulk Printing

External mail-house vendors

Application Process:

CLIENT BENEFITS

  • Compare performances of networks and providers to use the information for better rate negotiations
  • Define value drivers for members, their behavior and choices driving value
  • Take hold of analytical methods for assessing expected member value as well as actual performance
  • Assess trends associated with cost drivers for patient care, including unusual ones that differ from expectations- as in the case of payers identify health conditions, providers and patient types unveiling a situation where costs remain lower than expected

Download Case Study

Health Insurance Plan Aggregator

Health Insurance Plan Aggregator

Enchanced and re-architected insurance plan quotes engine that helped a leading health insurance plan aggregator to assess trends associated with cost drivers for patient care and deliver crisp information on healthcare plans to their customers

Key Requirement

  • Xoriant development team was engaged in designing and implementing the Windows desktop based Administration modules that automate Operations and Finance work flow functions.
  • The application automates tasks involved in enabling enrollment, termination, invoicing, renewals, accounting, disbursement, and reporting. Know More >>

Key Contribution

  • Xoriant used a blended delivery model that included on-site Xoriant project manager, on-site business analyst, o shore Xoriant developers and testers, and client team members.
  • Xoriant team, along with the client team, executed the project e ectively using the Agile methodology.
  • Xoriant leverages a cost-effective and e client offshore delivery model. Know More >>

Benefits

  • Compare performances of networks and providers to use the information for better rate negotiations.
  • Define value drivers for members, their behavior and choices driving value. Know More >>
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