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Integrated Data Management Systems through Pega Upgrade

Health Insurance Provider Data Management Solution

The Client is leading Fortune 500 Enterprise providing health insurance in the United States. As of 2018, the company had approximately 40 million members in 10 states in the US.

Key Highlights:

  • Highly adaptive Solution for greater user engagement.
  • Low Application Maintenance Cost
  • Improved Business Agility
  • Reduced Operating Cost
  • High Performance Platform

The Client caters to medical service providers, be it individuals or organizations. The Medical Service Providers often find it difficult to maintain a central data of their affiliates or their partner providers. This led to data duplication and errors which often cost the provider in terms of brand reputation and repeated effort cost. They needed a solution that provided an efficient and seamless data system, where the affiliate partner details were updated accurately and in place.

The solution built was a Provider Data Management Solution, with UI powered by PEGA 7.2, the interface development was powered by JAVA & for Storage, it was Oracle Database Suite. It was a rule-set based solution with over 172 rules, making the entire application extremely complex for implementation.
NV’s focus was centralizing these rule sets and leveraging parts of the code with clear focus on the business need. The resulting solution brought about benefits as below:

  • Solution is now more adapted to engage greater number of users through more channels and harness the power of big data analytics to provide better intelligence.
  • The Application enhancements and maintenance is now easier.
  • Improved business agility through Pega 7 by enhancing system development speed and accuracy.
  • Reduced on-going application operating costs with tools to proactively manage applications and robust infrastructure to eliminate unplanned downtime.
  • High-performance platform that is better suited to the providers multitenant environments, helping to reduce costs.

NV followed its template 3-point approach-

  • The Discovery – The NV Solutioning Team with deep market insights started interacting with the key stakeholders to understand their requirements and key priorities. In parallel, the NV tech Team interacted with the technical stakeholders to understand the core concern, so as to focus on the architecture in line with best practices.
  • The SoleTecture – This is a sprint phase where the Solutioning and the Architecture Team perform a series of brainstorming sessions to constantly challenge each other until they agree on a mutual standpoint solution that works best for the customer. The beauty of this exercise is that the Solutioning Team creates a Minimum Viable
    Product (MVP) with wireframes to ensure that the customer has the look and feel of the solution design way before the actual development
  • The Show – The entire exercise of this step is to ensure that the developers and QA team commence their development efforts to build the solution that fits the customer needs, against stringent timelines.

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