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A Fortune 500 US Insurance company meets Provider Data accuracy

The Business Issue

The customer has 100K+ providers (individuals and organization entities). While they continue to serve their customers, providers would like their data about various partners and their preferences, networks, addresses, etc. that they operate for, to be maintained accurately. The customer needed to have an application that will enable them to perform the data management activities efficiently. Their key business issues were:-

  1. Decentralized data management of the providers
  2. Higher turnaround time for the provider data to get updated
  3. Incorrect data processing for downstream applications consumption
  4. Inefficient handling of bulk change requests to the providers’ data
  5. The extensive manual effort to maintain data by the operations team
  6. Existing code issues acting as a hindrance to the overall operations

The application had to Go-Live by a particular deadline as certain providers and their markets needed to have that efficiency on an urgent basis to increase customer satisfaction and growth.

The Solution

New Vision Team based the entire solution on PEGA BPM & Case management platform. PEGA Case management brings together the people and information needed to get work done completely and correctly – the first time – every time. We used the following 3-point approach:

  1. The Discovery – The solutioning team interacted with the customer’s key stakeholders to understand the key epics of the requirements and their respective priorities. Along with them, a technically sound team interacted with the customer’s technical stakeholders to focus on the architecture and best practices for solution building & Environment profile data collection.
  2. The SoleTecture – A phase where the solutioning team and the architecture team performed a series of brainstorming sessions to mutually challenge each other and agree on the best solution suitable for the customer needs. The Team created mockups/wireframes to provide a visual representation of the application look & feel, seeking approvals before starting the actual development work.
  3. The Show – A set of highly skilled developers and quality analysts commence their development efforts to ensure they build the solution that best fits the customer needs with stringent timelines.

Outcome

  1. 3500 AGILE stories delivered in almost 30K person-hours with a strong technical team size of almost 100.
  2. Reduction in manual efforts of the operations team by 50% every day.
  3. Streamlined Data that is being consumed by 16 different systems bringing in great efficiency for the customer’s daily operation.
  4. Seamless enablement of Oracle FBDA providing a game-changer functionality to track all audit-related data against each provider to ensure legal compliance.