Integrated Web Platform for Multi-Entity Insurance, Transportation, and Language Service Management

The client faces challenges managing diverse processes including claims processing, transportation, translation services, and billing across multiple entities and formats. Existing systems are fragmented, leading to manual efforts, increased errors, operational inefficiencies, and delays in service delivery. There is a need for a centralized platform that consolidates all processes and enhances automation to improve productivity and reduce dependency on hardware and disparate tools.

A large multi-national service provider specializing in transportation, insurance claims processing, and translation services across various regions.

• Develop a centralized web application that supports management of multiple entities such as payors, service providers, and internal teams.
• Implement automated data extraction, validation, and processing for insurance claim files of various formats (Flat file, spreadsheet, EDI).
• Create unified interfaces for managing appointments, transportation, translation services, and billing lifecycle.
• Integrate third-party APIs such as mapping, ride-booking, communication channels (email, SMS, voice), and office productivity tools.
• Automate key operations including mileage calculation, ride booking, communication workflows, invoice generation, and claim reconciliation.
• Establish role-based dashboards and provider portals for task management, service review, and query handling.
• Ensure high scalability, secure data handling, and real-time reporting to support operational oversight and decision-making.

• Centralized management of entities including payors, providers, and users with detailed profiles and regional pricing rules.
• EDI and file import/export capabilities for claims and billing data, with automated validation and reconciliation.
• Appointment and service management modules covering transportation (ambulatory, wheelchair, air ambulance) and translation services (onsite, conference call).
• Automated mileage calculation using mapping APIs.
• Integration with ride-services like Lyft or Uber for automatic ride booking.
• Communication automation via email, SMS, and voice calls with pre-designed templates and dynamic routing.
• Browser-based IVR system for call handling and routing.
• Mass messaging and notification system for service updates and surveys using communication APIs.
• Document generation in multiple formats (PDF, spreadsheet, XML, TXT) for invoices, reports, and claims.
• Real-time dashboards and reports covering quality, productivity, sales, and service metrics.
• Provider portal for service review, task acceptance, payment status, and inquiries.

• Map APIs (Google API) for mileage calculations
• Ride-sharing APIs (Lyft, Uber) for automated transportation booking
• Communication APIs (Twilio) for SMS, voice, and fax
• Office 365 Graph API for email management
• EDI system interfaces for claims and billing files
• Third-party reporting or analytics tools as needed

• Scalability to support increasing volume of claims and service requests
• High availability and uptime (aim for 99.9%)
• Data security compliant with health information standards (e.g., HIPAA if applicable)
• Real-time data processing and reporting capabilities
• Responsive UI optimized for various devices and browsers
• Automated backup and disaster recovery protocols

The implementation of the integrated web platform aims to significantly improve operational efficiency by automating claims processing, appointment management, and communications. Expected outcomes include a reduction in manual effort and errors, faster diagnosis and resolution of service requests, enhanced response times through web calling features, and increased daily referral volume and productivity. Streamlining these processes will enable the client to better serve customers, expand service capacity, and reduce overhead costs associated with disparate systems and manual workflows.