Healthcare Claims Processing Automation

Client: Consolidated Healthplans Inc.

Job Title: Technical Consultant / Software Engineer

Summary: The client processes EDI data received to determine the validity of claims and what payments should be made. The process was highly manual and time-consuming. This situation resulted in a high-stress environment, with many supervisors/managers having to work long hours to fulfill their other responsibilities.

Actions:

Constructed a tool to manage the EDI process.

Trained less-experienced developers on how to improve and maintain software quality. 

Established coding standards appropriate to the business of the client.

Accomplishments:

Managers could now proactively manage the EDI process and fulfill their other responsibilities in a normal workday.

Instituted a new software development process to produce and maintain high-quality software in support of the business.