Warning: This is more involved to do than to write about! Compare this puff piece to the more realistic article (yes, the economy and insurance have a funky but predictable cycle):
Whether your insurance specialty is life, health, risk management, home owners, business owners, automotive, property and casualty, or whatever - we're still the consultants for you. As long as it requires eligibility determination. membership management, and claims processing, we have it covered!
New regulations have you stumped? Call us!
Need some DSS to determine gaps in your offerings? Call us!
Want to analyze your membership psychographics? Call us!
Do we know all the answers? Sadly, no. But we are happy to help you do the research to find the answers you need.
Some of our insurance-related experience includes:
- Participated in the Drug Data Processing System/Integrated Data Repository & Drug Benefit Calculator (DDPS/IDR & DBC) for Centers for Medicare & Medicaid Services (CMS) Medicare Part D Prescription Drug Program. Led the ETL/BI Reporting Team. Handled project planning and priority management.
- Set up the actuarial data mart. Developed the Decision Support Services (DSS) for the statistical control/actuarial efforts. Analyzed the membership and claims to support pricing determinations. Handled requests in this area by internal and external customers. Areas requiring further study were identified and presented to the actuaries. Developed and administered catalogs, cubes, on-demand and scheduled reports, user classes, and security.
-Participated in the Personal Lines redesign and expansion project. Modeled and developed a more universal interface appropriate for different states, countries, and assorted regulatory levels. Modeled and designed mainframe, server, and web applications (n-tier).
- Participated in the Commission Statement Redesign (CSD) project. Created a modular, flexible reporting system to provide customized statements with different levels and commission structures for the many companies under the corporate umbrella. Extracted the business rules for the varied organizations.
- Identified date and volume manageability issues with regards to patient eligibility. Set up date windows for eligibility data imported from health maintenance organizations, preferred provider networks, and private insurance. Set up reconciliation / correction procedures among these organizations. Set up "universal" import system for data mining/warehousing. Identified core information in mission-critical systems for disaster recovery and/or system migration between platforms, data analysis and data-mapping.
- Participated in the blending of IT streams to handle data processing for other Blue Cross Blue Shield organizations. Interpreted and implemented top priority changes to comply with new regulations. Identified core issues in system integration for expanded business area and database migration from TOTL to DB2, including impact analysis and data-mapping. This led to smoother transitions and pro-active enhancements.
- Analyzed claims in terms of risk management and fraud detection/prevention. This resulted in lower claims with the probability of even lower costs the following year.