One Inc ClaimsPay Integration

One Inc’s ClaimsPay integration is our major Midwest headquartered Insurance provider client’s ambitious electronic payment integration project.

Company Description

One Inc’s ClaimsPay integration is our major Midwest headquartered Insurance provider client’s ambitious electronic payment integration project. The client company partnered with digital payment vendor One Inc’s ClaimsPay which is a proven digital payment solution that empowers insurers to disburse claims payment to anyone, using any method, and from anywhere. Apart from major cost savings, the insurance company aimed to increase customer retention, cut costs, and reduce risk by delivering fast and secure digital payments through the end customers (including but not limited to Claimants and Vendors) preferred channels and methods.

One Inc’s digital payment solutions have a rich client base of 230 plus customers (and still growing), catering to close to 700,000 Vendors and Providers and making an annual payment volume exceeding $62 billion. In 2021, the client Insurance company became one of the several national Insurance companies to implement ClaimsPay Electronic payments.

Challenge

Problem

The insurance company was previously making most of the payments through physically mailed checks which cost around $25 to make a payment. Given the volume of Claim payments made on a daily basis, this was a huge operational cost to the company and also not in line with the latest digital modes of payments utilizing payment methods like “Direct Deposit”, “Debit Cards”, “Paypal”, “Venmo” and more.

The number one focus area was to understand the Insurance company’s existing legacy payment system that has been used for decades. The system that we were to design, and implement should work in tandem with one of the existing third-party payment systems (which would be retired soon after the ClaimsPay integration implementation) and also more importantly the existing claims system that is the backbone of the Insurance providers Claims business.

Project Goals

· Understand the existing Payment and Claims System.

· Architect to reverse engineer the to be retired – third-party payment system.

· Understand ClaimsPay API s, and feedback webhooks to implement the full payment cycle.

· Document and design the whole integration process.

· Implement to route the Claims payments through ClaimsPay API s to retire the legacy payment process.

Solution

We started by documenting all the tables and procedures, functions, and all the data objects that are involved in the existing payment system with ER, Logical, and data flow diagrams. We also created Architectural flow diagrams using Visio to understand the java and xml based tightly coupled legacy application framework that the Insurance company used to make the payments.

Created a unified .NET and SQL DB based Payment service application where the whole business logic for ClaimsPay payment processing resides to handle. We built methods to handle both the request and feedback response of the ClaimsPay API s and handle the CRUD operations from the DB2 based Claims System. The Payment data and Claims Data are managed through this central repository whenever a payment is made, and a payment response is received.

Innovations

To tackle the performance issues arising from the sheer volume of payments and other transactions, we implemented asynchronous processing wherever possible. A classic example is the usage of Azure functions that listen to events continuously and post payment Service Bus messages with payment payloads which are processed asynchronously to make further ClaimsPay API calls. Similarly, when a response to the payment was received as feedback to update the payment status from the source payment system, it was updated synchronously without adding load to the Online Transactions.

Implemented multi-factor authentications for the payments through client email IDs and text messages with challenge questions and created a useful functionality of stored payment methods the customers were able to utilize their preferred payment method for accepting payments from the Insurance provider quicker and eliminating the need to enter their payment details all over again from scratch.

Technical Stack

The following technologies were used to implement this functionality.

· ASP.NET Core

· ASP.NET Framework

· SQL Server Database

· DB2 Database

· Microsoft Azure Function Apps, APIM, Configuration Manage.

· Azure DevOps, Octopus Deploy.

· SPLUNK logging and Dashboards.

· Unit Test Frameworks

Several automated tests, automated Unit tests, and deep ping health check mechanisms were put in place for continuous monitoring of the system’s health and core functionalities.

Process

Claims Reserves and Payments Team

The team followed an agile process comprising of 2 weeklong sprints with sprint goals set and participated in several sprint ceremonies including Sprint reviews, Grooming sessions, and Retrospectives throughout the design implementation and testing phases. Major Epics from the business team were broken down into related Features and the Features were further broken down into smaller production deliverable User Stories. The whole team including the Developers, Quality Engineers, Business Analysts, and Product owners participated in the refinement sessions to assign story points, and the metrics were continuously monitored with set Sprint goals and quarterly goals.

Results

In addition to enabling cutting-edge electronic payment features to the existing check payment mechanism, this project saved millions of dollars to the Insurance company saving all the check fee per payment dollars to a huge volume of customer insurance claim payments. The payments also reached a wide array of customers including Insured persons, Claimants (single and multi-party), Homeowners and Mortgagees, Lienholders, Third party vendors providers, and agents in an automated process.

This project also enabled the disbursement of Payment with any modern payment method like Debit Card, Direct Deposit, Claims Card (Instant Pre-Paid Card), Mail Pre-Paid Card, PayPal and Venmo, and traditional Checks. It also made possible to disburse Payment from anywhere to pay claims & provide funds instantly during catastrophic situations with “CAT” cards.