SITUATION​

Our client needed to establish a platform to ensure the proper payment of all health claims, both pre-pay and post-pay. Their process to handle incorrect claims was highly manual, leading to the expiration of claims before they could be rectified, and funds recovered. Additionally, they needed their new platform to mitigate the risk of forfeiting recoverable funds due to the manual review process. With the clock ticking on each claim, there was an urgency to transform the operational infrastructure to prevent the loss of valid claims. Our client was searching for a robust solution that seamlessly integrates automated functionalities throughout the claims lifecycle, and they turned to Everforth Apex for that solution.​

Everforth Apex initiated our solution of a Minimum Viable Product (MVP), that would lay the foundation for a platform able to revolutionize the claims recovery process. Assembling a team of software development specialists, from backend developers to QA testers and DevOps engineers, we developed a state-of-the-art automation platform leveraging AWS's serverless architecture. With the incorporation of sophisticated technologies including AWS Lambda, EventBridge, and DynamoDB, our platform excelled in automating the processing of complex business rules for claims data and achieving unparalleled agility and precision. Through dedicated collaboration and bi-weekly sprints with our client's Scrum Master and Product Owners, our Agile team ensured the platform was meticulously aligned with the client’s objectives.​

RESULT ​

Advancing toward peak operational efficiency, Everforth Apex has successfully deployed the Simple Recoveries module, with progress into the Complex Recoveries segment actively underway. The feedback loop remains ongoing, driving continual enhancements to the platform. Everforth Apex's commitment to our client’s vision is not simply about modernizing a process—it's about creating a transformative shift in the payment lifecycle that has already begun to yield substantial increases in earnings for our client.