Our team decided to abandon the client’s original on-premises legacy platform and move toward a cloud-based option with a modern tech stack. Our course of action was to take an off-the-shelf enterprise resource planning (ERP) system and customize it heavily to address healthcare insurance needs. After evaluating various options, we chose Microsoft Dynamics 365, a modern general-purpose ERP platform, as the foundation. Our developers extensively customized this platform and adapted it to the client’s workflows and processes.
We made sure the solution is HIPAA compliant at every step of the insurance policy registration and management processes and that all personal data is safe. For this, we employed encryption and multi-factor authentication, regular audits, and compliance management systems, among other solutions. Our team also conducted staff trainings to make sure everyone understood and followed compliance practices. We also implemented strict access control, allowing authorized parties to only view the information that they were entitled to see. For example, the finance department could view every policyholder’s invoice details but not their medical history.
Here is what we did to support the independent agent workflow:
●
Implemented all the necessary features to increase agents’ efficiency. Specifically, the new healthcare insurance software enabled insurance specialists to create plans, sell them to both individuals and corporate clients, compare and customize insurance plans to find the best fit for a prospective buyer, access prospective buyer’s information within the authorization limits, register insurance policies, monitor claim and payment history, and more.
●
Enabled a safe interaction between the sales agent and customers through text and calls
●
Streamlined the process of policy approval and communications between independent agents and different departments within our client’s company, like finance and legal
●
Incorporated a comprehensive knowledge base on healthcare insurance information, such as pricing variations based on lifestyle factors and country-specific coverage
●
Automated some administrative tasks, such as calculating reimbursements on insurance claims, to reduce human error
●
Allowed agents to monitor accident history, calculate payments, and manage insurance claims with ease
To support the management, our team implemented:
●
Real-time analytics dashboards and self-service BI to generate reports on agent performance, sales metrics, marketing campaign results, and more. By analyzing policies and claims data, the system could reveal trends, like identifying the most costly healthcare providers.
●
Predictive analytics that could forecast sales, among other things
●
Enabled integration with external resources, allowing authorized parties to access a prospective buyer’s PHIs if they have the patient's consent or if it’s necessary for treatment, payment, or healthcare operations as part of the insurance plan approval process
●
Automated data backups to prevent information loss
●
Integrated a secure payment gateway so that the insurance company could process payments internally without diverting clients to other applications
●
Equipped the platform with customer relationship management features
●
Designed a scalable platform architecture that allows the client to expand their operations and accommodate the growing network of independent insurance agents
