Highmark offers an Enterprise Healthcare Platform which is an end-to-end solution for any health insurance company dealing from enrollment to billing, from suggesting providers to adjudicating claims and from providing additional services to sending an explanation of benefits to the end-user of the insurance products. Along with the consulting services, we also continuously develop and enhance our products to delight our existing and potential customers and provide the best care to the end customers. This project deals with automating the collateral generation process along with triggering member profiles based on the riskiness of scores decided by an AI algorithm base on multiple attributes ranging from hospital admits to a number of followups and from duration of hospital admits to initially submitted clinical authorizations submitted by a member or provider.
I worked in the capacity of Product Manager and Delivery Owner to deliver this project in 8 months. It starts with understanding the opportunity in the domain from the big picture. Post securing funding and onboarding of the core team (PO, PM, architects, and the specific department’s SMEs) with project and SAFe training, I kicked-off the project with all stakeholders with brief idea of what is project supposed to do. All the technology setup and reporting and communication expectations and channels were set up in this meeting.
After that comes the most interesting part of the project – Design Thinking. I am a detail oriented person and this is the phase of the project where I dig deeper into multiple details of the work effort. I encouraged every member to ask even dumb questions so that the final result of the process could be explained to a 20 year old. I utilized this opportunity to ask all possible questions that I speculate that might come later in the process. This prediction comes from my experience of leading and programming in software development when I was working with Samsung. Parallelly, I could also represent the marketing and sales team here and sometimes bring them onboard to align all the upstream and downstream stakeholder from the initial design phase itself. I facilitated the design team in creating the user persona, futurestate process flows and epics which were further broken down into high level stories. Parallelly, I had to keep the scrum team ready for sprint 0 where final detailed stories will be created for sprint 1. Hereafter, the development continued under the hood of product owner and I stepped back but continuously handled the confusions and blockages with clear and concise communication among multiple stakeholders while taking one sprint over other till the release train. With regular communication with marketing, sales, actuaries, vendors and leadership, I ensured everyone has what they need while diving deeply into the data requirement and attribute selection meetings so that the fins ML base product does as per the product's vision and does not produce completely off-track results due to flaw in data selection. On the whole, I