The client is a leading American health solutions company that owns a retail pharmacy chain, a pharmacy benefit manager, and a health insurance provider, among other brands.
The company used to process and validate claims through their claims adjudication platform (PBM) but they wanted to migrate more customers to their own platform. However, different PBMs have distinct rules associated with different claims, causing challenges in onboarding new customers.
Our primary objective was to identify mismatches between two PBM platforms, detect defects and anomalies, and align the PBM rules to ensure optimized PBM migration. We leveraged an AI-driven system to streamline the manual testing process and successfully developed a certification testing solution utilizing Big Data implementation blended with Machine Learning (ML) to process records from both PBMs and run a hi-speed comparison algorithm to find mismatches.
Following were the notable business outcomes:
The client provides business solutions to small and medium sized organizations all over the US. The actual end users of the application were a HealthCare accreditation organization. The Project was to develop a system that will help the client to provide maximum business for healthcare accreditation.
e-Zest is a leading digital innovation partner for enterprises and technology companies that utilizes emerging technologies for creating engaging customers experiences. Being a customer-focused and technology-driven company, it always helps clients in crafting holistic business value for their software development efforts. It offers software development and consulting services for cloud computing, enterprise mobility, big data and analytics, user experience and digital commerce.