BlueCross BlueShield of Michigan
Profile
With pressure to keep health care costs down and grow the subscriber base, this top-tier heath insurance provider needed to find ways to improve claims processing rates while decreasing costs. With an expected 35% increase in the number of claims, business process improvement was imperative to their SOA and legacy modernization initiatives.
With claims processing supported by mainframe 3270 applications that evolved over a number of years and passed off for processing to a 3rd party claims processing entity, there was no detailed understanding of the process inefficiencies. To solve the problem this health insurance provider deployed OpenConnect’s Comprehend, Configure and Connect solution.
Solution
OpenConnect’s Comprehend solution provided exact details on the manual claims processing business process. Comprehend created the business process maps including the probabilities of executing process variations, the data that invoked those sub-process variations, as well as the human behavior patterns, think times and error rates associated with the process.
OpenConnect’s Configure product was then used to quickly configure the appropriate mainframe service. To configure an improved process proved simple when armed with the detailed business process extracted from Comprehend.
The final step was deploying the run-time connection to the mainframe provided by OpenConnect’s Connect product line which provided a highly scalable and secure connection to the business process and data encapsulated in the mainframe system.
Benefits
Significant improvement in first pass claims rates reduced claims processing costs and provided 30% more claims processing capacity. More importantly, a 4 month payback was achieved on the initial investment.
Western Reserve Group
Profile
This Ohio based insurance company specializing in P&C, Auto & Homeowners insurance provided its network of independent agents rate quote and application print capabilities through a proprietary rate diskette. This antiquated system presented a number of challenges both for The Western Reserve Group (WRG) as well as its agents.
Maintaining and updating the diskettes posed both administrative and maintenance issues. Each rate change required a redundant update of tables, programs and business logic, not to mention separate acceptance testing and mailings to agents.
WRG clearly recognized the value of providing direct access to the mainframe via Web services to eliminate redundant development and maintenance of rates and redundant data entry.
Solution
OpenConnect’s Configure solution was selected asthe rapid application development tool to encapsulate the mainframe data and navigation and deploy to a J2EE server. Configure was used to access the Policy Issue System residing on the mainframe and was able to rapidly develop a Web-based, HTML and Java Server Page (JSP) presentation which allowed hundreds of agents to complete homeowner rating tasks online.
The solution provided agents with secure real-time access to accurate rates, allowing them to easily enter the information necessary to provide customers with quotes and then convert quotes into an insurance application without re-keying the information.
Benefits
Within the first month after launching the new Web-based rating system, WRG reached 100% of its anticipated utilization and issued over 4,000 quotes through the new system. Because quotes are being converted to an insurance application without re-keying information, data entry errors have been eliminated. As a result, rates are more accurate and agents are now able to quote across rate periods, allowing them to deliver more timely and improved service to their customers.
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