Development of a Comprehensive Benefits Administration Platform with Advanced Rate Rules and Self-Service Portals

The client faces complexities in managing benefits with diverse rate rules, extensive manual processes for enrollment and life event reporting, and fragmentation across portals. Existing systems struggle with scalability, flexibility in rate adjustments, and ensuring compliance with industry standards such as HIPAA, ADA, PCI, and GDPR.

A mid to large-sized insurance company specializing in employee benefits management seeking an integrated solution for rate calculation, benefits enrollment, and compliance management.

• Implement a flexible and scalable rules engine capable of condensing complex rate logic into manageable code lines to improve maintainability and reduce errors.
• Develop comprehensive billing and invoicing modules to streamline financial operations and facilitate easy reconciliation.
• Create self-service portals for employers and employees to manage benefits enrollment, life event reporting, and administrative tasks efficiently.
• Integrate advanced validation services such as address validation and external vendor systems to ensure data accuracy and compliance.
• Ensure system security, HIPAA compliance, and support for multiple payment options including ACH transactions.
• Establish a robust architecture to support future scalability, high availability, and seamless integrations.

• Complex Rates Rules Engine capable of handling detailed benefit rate calculations with concise code logic.
• Complete billing and invoice management system with reconciliation features.
• Employer and Employee portals for benefits enrollment, claims, and personal data management.
• Life event reporting modules for changes in employee status or benefits.
• Entity and Employee Management modules for administrative oversight.
• COBRA Administration capabilities for compliance with federal regulations.
• Ecommerce functionalities supporting ACH payments.
• Dual-Factor Authentication Services to enhance security.
• Address validation and external system integrations for data accuracy and compliance.

• Address Validation Service (e.g., USPS Address Validation)
• External Benefits and Insurance Providers (e.g., Kaiser, Delta Dental, etc.)
• Payment gateways such as CyberSource for payment processing
• Health and benefit compliance systems
• Cybersecurity services for authentication and fraud prevention

• System must support high availability with 99.9% uptime
• Data security compliant with HIPAA, GDPR, and PCI standards
• Scalable architecture capable of handling hundreds of thousands of employee records
• Responsive UI with fast load times across devices
• Automated testing and deployment pipelines for continuous delivery

The implementation of this benefits administration system is expected to streamline enrollment and benefits management processes, reduce manual errors through automation, condense complex rate rules into manageable code for easier updates, and enhance compliance with industry standards. This will lead to faster processing times, improved user experience for employers and employees, and significant operational cost savings.