Healthcare Go-Live

computer files

Healthcare Go-Live A large health insurer needed to upgrade their legacy system that was taking up to 40 minutes to process batches of 5000 Medicaid enrollment transactions. The Problem A health insurace company, with more than 1.2M members, legacy system was taking between 20 to 40 minutes to process batches of 5,000 Medicaid enrollment transactions: […]

End-to-End Group Quoting Process

insurance quoting

End-to-End Group Quoting Process A US-based health care insurer needed a tracking and processing system for their prospective and existing clients. The Problem As part of their yearly sales process for small and large groups, our client quotes many products to their current and prospective clients. They needed a system that allowed them to track […]

Health Insurance and Pega Re-Architecture

call center

Health Insurance and Pega Re-Architecture After investing in Pega and two years of work, a US-based health insurer enlisted Rulesware to upgrade and re-architect their call center solution. The Problem This health insurance client needed an upgrade and re-architecturing to address some existing Pega functionality concerns, improve time-consuming processes and support some upcoming nationwide health […]

Pharmacy Claims Processing

pharmacy

Pharmacy Claims Processing A pharmacy client whose primary business was processing claims for health insurers, employers, individuals and seniors on Medicaid needed a more efficient intake process. Rulesware was tasked with automating an entirely manual intake process. The Problem The client had several manual intake processes that would dump the corresponding requests into an enterprise […]

Non-Profit Care Management Services

not for profit data agile

Non-Profit Care Management Services A non-profit organization providing professional care services and financial assistance to patients, with serious health conditions, needed a new way to handle manual processes. The Problem A non-profit care services organization, who was using manual data entry and processes to provide care management services, provide financial assistance and track charitable contributions, […]

Diagnostic Testing Services

diagnostics lab

Diagnostic Testing Services A diagnostic testing provider needed a universal method of collecting, storing and distributing data. Ruleswares was asked to work with this existing Pega customer to leverage and consolidate their distributed data and existing inefficient processes. The Problem Scientists and lab professionals were generating data that was entered and dissimenated across a range […]

Not-For-Profit Health Insurance Company

health insurance

Not-For-Profit Health Insurance Company When our client came to Rulesware, they needed to transform their expensive, unscalable, error-intensive manual processes with digital automation. This client specialized in underinsured, mostly Medicaid participants, and needed to strengthen their relationships with their Provider network(s). The Problem The client’s legacy tools were opaque and difficult to modify, had slow […]

Automate Healthcare Business Processes

healthcare business

Automate Healthcare Business Processes A healthcare insurance client was overly dependent on manual processes and lacked a single data source for their product catalog, which was preventing them from optimizing their business processes or expanding their sells beyond the existing products. The Problem The client needed to improve their Product Lifecycle Management and enable the […]

Medicaid Enrollment Automation Streamlines The Member Journey

Medicaid Enrollment Automation Streamlines The Member Journey Efficient, customer-centric enrollment for Medicaid has been an ongoing challenge for insurers across the country. Those challenges peaked during the COVID-19 pandemic and the nation’s subsequent response to ensure healthcare was available for those impacted by job loss. In 2020, millions of people lost their insurance coverage and […]