Major Trends in US Healthcare

Volume 39, Aug

20

CASE STUDY
Values Delivered:

Claims Platform Development for

Health Insurer in India
Project Duration: On-going since November 2012
Service Family: Operational Improvement, Digital
Transformation
Teams Involved:

CBC HC

Healthcare Vertical

Cognizant Interactive
Client Overview:
The client is one of the largest general insurance
companies in the Indian insurance market, providing
services across multiple LOBs including Healthcare;
others being Motor, Travel and Home. The client
provides both Group and Individual insurance via
multiple plan types with a distribution network of 130
branches and over 4000 network providers.
The Engagement:
Before the engagement, clients claim approval
process involved a lot of paper work, manual
intervention and hand offs. Client was looking to
automate the entire process.
CBC HC anchored the functional scoping activity &
detailed out the requirements for all the modules
including Policy Setup, Enrollment, Endorsement, Preauth
workflow,
Claims
Processing,
Network
Management, Products Set-up, Reserve Management,
Investigation, Reports, eClaims tracking, Outpatient
Cashless workflow, Templates, Provider self- services
and integration with accounting system, customer
service application.
This engagement followed a multi-phase approach
with modular roll out of functionalities. Key aspects of
the claim system built are:

Best-in-Class Benchmarking- Benchmarked

existing health claims system against industry
standards to drive the transformation roadmap
End-to-end Claims Platform- First-of-its kind
Ground-up Development
State-of-the art User Experience
Automated Workflow

With the claims process transformation and ground up

claims platform development engagement, CBC HC
established its capabilities in the India Health
Insurance arena.
CBC HC is involved right from the Define till the
Implementation phase which has brought significant
expertise and helped in similar new wins and
executions.
Assets/Frameworks:
Following assets and accelerators were built as part of
the engagement:

Exhaustive list of use cases for each module

Functional Blue print of Health Insurance Eco
system
Requirement Management Effort Estimation
Template

Client Benefits:
This engagement is aimed at helping the client to
reduce manual interventions, streamline the claim
approval process and integrate other applications in
the eco system with the claims platform. Following are
the direct benefits of the engagement:

Cost reduction
Streamlined processes & operational efficiency
Faster turn-around time (reduction in per claim
processing time)
Improved customer satisfaction

The System is fully operational and currently running

with Zero Backlog. The system supports following
volume of transactions at present:

8+ lakh Member Enrollments

3000+ Claims Processed Per Month
4300+ Network & 47,000+ Non Network
Hospitals Setup
800+ Corporate Policies

CBC HC Leads:

Achilles Pereira (330120)

Nayana Rao (335885)

2015 Cognizant's Global HealthCare Research Institute, Confidential