AI based enhancement of Enterprise Healthcare Platform (Highmark)

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.

My Role
Product Manager and Delivery Owner
6 Months
Skills Used and Nurtured
Product Management, Project management, SAFe Agile application, Design thinking
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The Challenge

  • This was unique since no one knew how machine learning projects work and it was difficult to convince about the uncertainty and huge data dependency of machine learning projects to the leadership.
  • Tackling the employees’ resistance to change the mind of senior employees who are working from 30-40 years in the organization.
  • Convincing everyone to use the SAFe agile methodologies and bring everyone on board while creating genuine excitement about the new process.
  • After all these, delivering the project within the time frame required a lot of forecasting of people’s behaviors, timelines, technical complexities, and technical debts considering the big change and new delivery process.

The Process

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

  1. was accountable for the successful(on-time and within budget) completion and delivery of his/her project(s) while adhering to standards as established by Program Delivery
  2. was responsible for planning and communicating key milestones for project delivery in adherence with guidelines established by Program Delivery
  3. defined the project responsibilities and level of authority for each project team role using documented delivery model
  4. facilitated and participated in project ceremonies including Design Thinking sessions
  5. established project teams, work streams,and quality management
  6. worked closely with the project architecton the project to ensure that the project solution is meeting its business,functional, and technical requirements
  7. was responsible for quickly solving impediments open for more than 24 hours
  8. communicated with marketing, sales, actuaries, vendors and leadership, I ensured everyone has what they need
  9. dove deeply into the data requirement and attribute selection meetings so that the fins ML base product does as per the product's vision
  10. Identified and noted risks and issues that could have been escalated to the program and executive leadership
  11. communicates project status, resource burn rate, and RAID logs to all stakeholders including Dyad Leads
  12. served as point of project-specific escalation for the scrum master

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The Impact

  • Simplified the process of SBC creation
  • Created a seamless method to create the collaterals while saving x hours of manual work while improving the quality ofx percent. This did not only saved on cost on quality but also proved to be a good benchmark MVP for all upcoming process and opened the way for future funding for business process automation work stream
  • Ultimately, it directly impacted our clients and their end customers (insurance members) by timely and quickly proving them the collaterals related to their health insurance and claims leaving less frustration and increased level of trust and sales.