Technology Consulting (Highmark)

Highmark offers an Enterprise Healthcare Platform which offers 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 explanation of benefits (EOBs) to the end user of insurance products. Along with product development, Highmark also offers consulting services to existing and new clients to improve their healthcare care management by creating a customized version of our proprietary enterprise platform. This was a consulting project with 'Independence Blue Cross' who requested us for methodologies to onboard their newly acquired largest client – Comcast. Along with the consulting, we also had to provide them the solutions if the proposal was accepted.

My Role
Consultant
Year
2020
Duration
8 Months
Skills Used and Nurtured
Consulting, Research and presentation, Working under pressure while while maintaining quality
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The Challenge

  • Huge client and hence no scope of mistakes
  • Time limitation for consulting to provide more time for development and testing
  • Customer’s request of a non-traditional way of adjudicating claims which was never implemented by Highmark and was probably very new in the industry
  • Communication challenge due to travel and office resource restrictions

The Process

I delivered this project in the capacity of an Associate Consultant. My role was to understand the customer’s requirement and suggest, document and deliver the solution within a specified timeframe and constrained budget. On approval, this will be taken ahead for development by the different product team at Highmark.

Understanding the requirement was challenging due to pandemic restrictions and travel restrictions. I used Mural and MS Visio to layout customer processes and suggest the change that they need to accommodate in their system to onboard and manage such big clients like Comcast on the platform. After understanding, I had to do my homework and consult with the team for suggestions and future obstacles. Continuous involvement from the product team was required since the Highmark product team only commissioned for development. This made life a little easier though since I could learn the limitations of the system and consult and suggest the customer accordingly. Post, multifunctional and multilevel discussions with the customers’ and Highmark’s teams, I prepared the initial draft of the proposal.

This draft was then scrutinized on the customer side to come up with all questions from multiple departments from finance to legal and from product to leadership. Third draft was finalized for approval and presentation to the executive leadership. 90% of my role ends here except for some consulting help which I provided to support the development and to understand the idea behind the proposal when the actual implementation started. This was a high risk, high gain project and hence, I had to be very critical in every line of the proposal and presentation of the proposal. While creating a future proof proposal, I had to consider the development methodology to the testing type and effort as well, to create a perfect proposal that is well thought from all perspectives.

The Impact

  • All Comcast employees (number) were now on-boarded on IBC’s Product
  • A back-patting for Highmark from the customer for implementing it in short time
  • My work was highly visible and recognized due to its importance for the customer and I was offered another consulting opportunity for IBC