Benefits Configuration and Management System
The Problem
Our Large Health Insurance Company was midway through the requirements analysis portion of a 5 year program of business process re-engineering to change the entire way they specified coverage rules, provisioned benefits, and processed claims. Jonah won an RFP to build this system, and was engaged to complete the requirements analysis phase, to perform the architecture and detailed design, build the system, and to support the end-to-end integration.
A major goal was to strengthen and support the automated submission and processing of claims by capturing all benefit rules and medical policies within a single source of truth - the Benefits database, and by providing tools that simplified the process of codifying and formalizing rules found in all policy and contractual documents.
The new system disseminates and integrates this centralized benefit information across all business processes, and also facilitates the creation of new health insurance offerings for existing and potential clients. The Jonah Group was asked to deliver our full suite of software development services to bring the new functionality to fruition over the course of the next 16 months.
Our Responsibilities
- Project planning and timeline estimation
- Management of a team of up to 20 people
- Participation in UI design discussions, creation of mockups
- Technical Architecture / Design for all features and functions
- n-tier enterprise software development using leading-edge technologies
- Quality Assurance
- Assist integration with the wider business systems and activities
- Ongoing Communication with our client's Technical Delivery Manager, Lead Architect, Lead DBA, Project Manager, Business Leads, and Developers.
The Solution
Jonah provided a project manager, a senior technical architect, three technical architects, a business analyst, a DB specialist, a UI designer, 10 software developers and a QA specialist to deliver a complete solution with the following features, components, and technologies:
Features
- Benefits Rules Provisioning and Editing
- Benefits Contract Assembly
- Policy Document Markup
- Rules Translation for Claims Processing
- Multiple "Benefits Explanation" views
- Interfaces with related business systems
Components
- Document Editor
- Policy Assembly Tool
- Benefits Services Tier
- Benefits Database
- Benefits Explainer services and web applications
- Benefits Editor
Technologies
- Spring MVC
- Prototype JavaScript Framework
- MS Visual Basic
- DOM2J / J2DOM, MSXML
- XML / XML Schema
- Session Beans
- Java / J2EE
- Websphere Application Server
- MQ Series
- Oracle 10g
- AJAX
Unique Challenges, Solved.
- A variety of technologies were were chosen and applied, to fit with the company's existing software development assets, and to modernize their ability to enhance the application in the future.
- The system supports a wide range of internal and external users, including rule authors, document editors, customer service representatives, sales reps, policy holders / members, and providers. It represents a completely new approach to the way benefits are provisioned and disseminated, and over which claims are processed. The new system significantly streamlines many manual processes and workflows.
- Jonah has successfully delivered the 7 iterations of the software. Earlier iterations enabled the complex data capture processes to proceed, and the 8th and final iteration is scheduled for pilot production in June 2008.
- For this project, Jonah managed a very complex development environment, which supported team development along multiple concurrent streams, to increase efficiency. A combination of JIRA, TeamCity, and custom tools were provisioned to successfully solve the difficult problems associated with this style of development.
- Questions? Ready to move your project forward? We'd be happy to discuss a solution for your needs. Contact Us to find out more.
