Securing a healthy future for a leading global Health Insurance & Care company with ADMnext

Client: A leading international Health Insurance and Care company

Industry: Healthcare Insurance and Care

Client Challenges: This leading UK-based, global Health Insurance and Care services company was looking for a partner to support and guarantee a smooth, stable customer experience for its insurance policy administration platform.

Solution: Capgemini’s ADMnext supported the client’s comprehensive health insurance policy administration platform. This platform covers enrollment, pre-authorizations, claims, billing, payments, renewals, group and member data, and pricing, and holds details for close to 100,000 organizations and providers and five million members.

Benefits: 

• Substantial cost savings with better predictability, year-on-year productivity gains, and a reduction in manual efforts
• Service improvements with increased support coverage, predictability in resolution and response times, reduction in incidents, and exceeding SLA targets
• Quality improvements with better application health, and increased accuracy and efficiency
• Process improvements resulting in substantial work hours saved through a streamlined onboarding process for new applications and services, and transparent and secure support service governance

Addressing an unstable insurance policy administration platform

Connecting with and bringing customers relevant offerings is crucial for surviving and thriving in the Health Insurance and Care industries. However, the client’s unstable core policy administration platform and a changing customer user base were leading to higher volumes of incidents. In addition to IT budget pressures and a lack of control on monthly application usage maintenance outflows, the client was facing major business efficiency issues, which were leading to unhappy end customers. This called for improvements in governance and incident management.

The client was also seeking to address turbulent support services with improvements in the on-boarding of new applications and releases and extended support coverage. There was a lack of documentation and high levels of inadequate knowledge in the L1 team. The routine, manual, and clerical tasks were resulting in loss of productivity.

Capgemini’s ADMnext to the rescue

To address these challenges, Capgemini’s ADMnext supported the client’s comprehensive health insurance policy administration platform built on .NET and Oracle technologies.

Firstly, Capgemini carried out a detailed assessment for the client and various critical success parameters were identified. Capgemini then proposed a fixed monthly fee and managed services contract with high offshore leverage. Predictability in incident management was greatly improved here with effective use of SLA and OLAs throughout the engagement.

Next, Capgemini leveraged its transition methodology to streamline the onboarding of new applications and ensure a smooth transition from development to support for regular releases. Operational manuals and user guides were developed to improve application knowledge for first-line support. Along with automated monitoring of applications, batches and identification of data inconsistencies were improved by implementing tools like Selenium and Point Scripts. Additionally, a continual service improvement (problem management) model was introduced to address repetitive incidents and frequent process errors, along with scoping out the functionality changes required to cater changing business needs.

Overall, these initiatives brought the following benefits:

• Substantial cost savings with better predictability from a fixed-fee pricing model and high offshore leverage (~85%); year-on-year productivity gains (~5%) and a reduction in manual efforts from automation initiatives
• Service improvements with increased support coverage, predictability in resolution and response times, reduction in incidents, and the exceeding of SLA targets
• Quality improvements with better application health and increased accuracy and efficiency resulting from Capgemini’s Continual Service Improvement (Problem Management) model
• Process improvements resulting in substantial work hours saved through a stream lined onboarding process for new applications and services, and transparent and secure support service governance.

The way forward with ADMnext

Capgemini will continue to work with the client and help them achieve their business targets and customer service excellence goals. In moving forward together, there are plans for an overall web upgrade that will encompass all web applications. There are also plans to work on security vulnerabilities for these web applications, along with looking for new opportunities in the form of digital, and development and support in the ECM and CRM spaces.

Additionally, Capgemini is committed to decreasing the incident count across all services through automation and process improvement, while working more effectively with tools like Smart Analytics to better understand incident trends and avoid as many incidents as possible in the future.