The Client: A US-based regional health insurance provider offering care plans and Medicare coverage.

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 both the quoting process and the way sold products were processed, from setting up membership through to processing claims. Our client originally spent more than a year building an application to do this, but the results were not what the business needed or wanted. As a temporary workaround, our client began to use a spreadsheet that tracked work as it moved from stage to stage within the Pega application. However, the process was extremely manual, requiring significant manual data entry, and therefore contained considerable risk of error.

Rulesware’s Approach: Rulesware was brought in both to revamp the application in order to make it more manageable for our client’s end users, and to improve the overall business process to reduce risk and provide visibility to the organization. Rulesware’s team consisted of three US team members and three El Salvador team members. The team spent a few weeks analyzing the needs of the business before helping to redesign the business process and the application using Pega’s Group Sales Process Manager (GSPM).

The Results: In delivering this project, the Rulesware team created a single end-to-end process, reducing manual data entry and introducing SLAs and increased visibility to applications throughout the process. The project went live in August 2015 and represents a second successful delivery to this client. (Rulesware successfully delivered an Appeals and Grievances application for this client that went live earlier in the year.)

The project was delivered on time and under budget and it was completed in only 14 weeks.  

As a result of the efficient delivery of this project, the business was able to successfully launch this improved process and application in time for open enrollment, our client’s busiest time of year.