Insurance Eligibility Workflow Engine - A Case Study

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Harbinger Systems - HRTech Builder of Choice

An e-Business application that computerizes eligibility workflow through a flexible, rule-based engine requiring no programming, this application enables quick authoring and implementation in the face of changing eligibility policies and regulations.

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HSTC301 ELIGIBILITY RULES FOR INSURANCE ECOMMERCE PORTAL www.harbinger-systems.com

HARBINGER SYSTEMS Overview Harbinger Systems is a leading provider of software engineering services to some of the world's best product companies. Our services span solution consulting, software design, development, testing and test automation. By leveraging cutting-edge technologies, Harbinger Systems works with its customers as a partner in technology innovation. Services ,[object Object]

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Insurance Eligibility Workflow Engine - A Case Study

1. HSTC301 ELIGIBILITY RULES FOR INSURANCE ECOMMERCE PORTAL www.harbinger-systems.com

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13. ELIGIBILITY RULES FOR INSURANCE ECOMMERCE PORTAL Challenge Eligibility rules needed to be flexible and easily configurable Rules change frequently with time due to changing policies and regulations Rules implementation required automation with no programming Situation A brick-and-mortar insurance company creating an e-Business app to computerize eligibility workflow Harbinger Solution A binary-tree-based eligibility encoding proposed Intermediate nodes were eligibility questions and terminating node were actions Oracle RDBMS tables used to encode binary tree structure of eligibility workflow The largely static eligibility question nodes were encoded as DB stored procedures COM component developed to run through encoded paths and fire questions to arrive at required action Technologies & Tools Oracle RDBMS Binary tree representation in RDBMS tables Component Object Model (COM) Benefits Company encodes insurance eligibility workflow automation with no-programming Frequent changes in eligibility can be incorporated within hours instead of days BOTTOM LINE Company implemented a complex workflow automation that required no programming and maximum flexibility to match frequent future changes www.harbinger-systems.com HSTC301

Insurance Eligibility Workflow Engine - A Case Study

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