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Written by xScion
on June 24, 2020

 

System Refreshed with 60,000 Claims Daily

10,000 Per Week OPL Claims

2,000 Per Day Salesforce CRM Inquiries

 

The client, a large Blue Cross Blue Shield plan with more than three million members, wanted to leverage their data resources to solve other party liability (OPL), duplicate claims and storage issues by enhancing their analytics capabilities. xScion successfully led the way by developing a data strategy, designing the architecture and managing the data ingesting and analytics.

 

The Challenge

The client needed to better understand their claims data to reduce liability, fraud and overpayment through a data analytics platform. To do this, the client was challenged to mitigate the complexities of OPL, reduce duplicate claims and improve reporting. They also sought to reduce data hosting costs and develop analytical tools to leverage their data more powerfully.

 

The Change

xScion created and implemented a strategy that leverages data tools to improve claims processing and utilizes managed Cloud services to host large quantities of data. An architecture and data environment were developed that include a data lake and Cloud infrastructure, daily ingestion of claims data and business intelligence analytics tools.

 

The Value

data analytics platform was successfully launched that achieves business goals, reduces costs and dependencies on expensive hardware and identifies patterns of fraud and claims system errors. xScion helped the client expand the platform’s impact and deepen business intelligence by developing proprietary analytics tools that:

  • Integrated with the client’s claim bridge system
  • Migrated all primary reporting to the platform

Data hosted in the new data lake handles 60,000 daily claims, 10,000 weekly OPL claims and 2,000 daily Salesforce/CRM inquiries.

 

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