Complaint Management System
Our client needed us to develop an IT solution that would allow them to manage their appeals efficiently. In a short time, Vicert implemented a configurable solution that improved the client’s overall workflow and supported different entities: Medicare, Medicaid, Commercial, Health Insurance Exchanges, ACOs, and others.
Full Stack: Java, jQuery, Drools
9 months
Challenge
Our client wanted us to develop an app that would help payer entities process virtual appeals in a legally-compliant way. Vicert needed to implement a complaint management software that would provide a high customization level pending the client’s specific business needs.
We needed to make it secure and capable of mitigating risks for entities such as Medicare, Medicaid, Commercial, Health Insurance Exchanges, ACOs, etc. The additional level of customization was needed to serve multiple clients to answer their particular needs.
Our client built their first product in their portfolio as economically as possible - there was a lot of “spaghetti code” under the hood. Vicert needed to develop complaints management software as the foundation for the client’s future projects - we designed a platform where all their future projects could sit and interact with other products in their portfolio.
Solution
Our greatest challenge was that the client didn’t fully articulate their needs. We received the requirements as an MS Access mockup containing only about 20% of the actual project scope.
That is why we had to sit with the client’s Chief Compliance Officer to develop our complaint management system by defining the remaining requirements and helping the client prioritize product features.
On the technical side, we had to deconstruct the client’s current software to understand its inner workings and architecture. Based on what we found and the client’s input, we developed an IT architecture that would provide the most flexibility for the client’s future product integration.
We made recommendations related to the structure and design of the shared data store. Our customer complaints software improved the client’s security model, rules engine, and UI.
We opted to utilize the following technology: Java with Spring and Hibernate frameworks for the backend, jQuery, RequireJS, and Handlebars for the client frontend. We also used a powerful rules engine based on Drools for automated case-processing and decision-making.
We named the solution Virtual Appeals Manager (VAM), and it included a fully configurable workflow with support for detailed customization of all its aspects. Our VAM complaint management software also had extensive reporting based on Jasper Server and an automated system for importing large data sets from third-party systems.
Benefits
We managed to deliver the project in a short amount of time. Using Agile Scrum project management methodology, we saw the project through its entire lifecycle and exceeded the client’s expectations for dollars spent.
We created an MVP in six months, allowing the client to start collecting their ROI.
After nine months, our client a product they could deploy to customers.
Our complaint management system was highly configurable, supporting multiple workflows of various organizations such as Medicare, Medicaid, Commercial, Health Insurance Exchanges, ACOs, and others.
