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Case Study

Leveraging Information—Updating Infrastructure at a Medical and P&C Claims Processor


Company Details

Industry: Insurance (Medical, and Property & Casualty)

Company Size: 400 employees

Location: USA

Products: Medical Claims Management Software

Cprime Services:

Overview

This Cprime client offers a comprehensive suite of technical software solutions for medical and insurance claims management. They help their partners maximize efficiency, improve decision making, and reduce ROI while enhancing claims outcomes in the Medical and Property and Casualty (P&C) markets.

Their proprietary, HIPAA-compliant management platform is derived from 35 years of industry experience. It streamlines the medical claims process by facilitating services that range from peer reviews and independent medical examinations to medical record reviews and field case management. The company’s solutions serve major regional and international insurance providers in the Northeast US.

Seeking Improved Reporting, Planning, and Accountability

The company provides software-as-a-service in the competitive, highly regulated, and ever-evolving insurance claim management sector. They wanted to increase organizational and DevOps efficiency around planning, quantifying, and tracking work at the task, project, and portfolio levels.

“Their developers are responsible for both support and development,” explains Drew Garvey, Cprime Delivery Manager. “And they had a lot of fly-by requests, emails, phone calls, and Teams messages they struggled to track. The existing infrastructure was hindering their development work.”

To address this, the claims management provider had two primary goals. “First, they wanted a framework to better organize their work-in-flight, project work, and support-related jobs,” says Garvey.

Second, the company needed a platform that provided real-time reporting, increased the accuracy of timelines and estimates, and improved transparency on work assignments and progress. “They wanted to scale their development and planning infrastructure for larger projects,” Garvey summarizes.

Choosing the Right Partner

A Project Management Organization (PMO) had been established to oversee processes and internally promote agile methodologies, and they turned to Cprime to update their development infrastructure. “The company came to us based on a prior collaboration,” says Garvey. “We had worked with them several years ago to move their SharePoint and Excel-based manual systems into a Jira Cloud environment.”

Cprime began with a site assessment. “We set up several interviews and worked with our executive sponsor from the PMO and the stakeholder teams in discovery workshops to determine their current tools and processes and identify gaps,” says Garvey. “From there, Cprime developed a backlog within their Jira platform and built out the implementation plan for a framework that would promote alignment while they scaled.”

Tooling up with Structure for Jira Cloud, Advanced Roadmaps, and Jira Service Management

strategic consultingCprime began by implementing Jira Service Management across the organization to reduce interdepartmental silos, foster streamlined collaboration, centralize task tracking, and allow them to respond more proactively to service requests.

“The company now has the information it needs to more effectively estimate and complete work based on their current teams’ available capacity. More importantly, they can determine if they need to augment staff to achieve future strategic goals.”
— Drew Garvey, Cprime Delivery Manager

At the portfolio and project levels, the Cprime team expanded the company’s limited Jira Cloud implementation with Structure for Jira Cloud and Advanced Roadmaps (Jira Premium). This provided the PMO and executive teams with enhanced planning capabilities, allowed them to scale and track plans and dependencies across multiple teams and provided a single source of truth for reporting progress.

A Wealth of Information

“Ultimately, Cprime created an intake form using Jira Service Management for support and for feature requests,” says Garvey. “That implementation affects all areas of the company, especially the development teams, integration teams, and DBAs who each have their own little slice of Jira to manage work assignments.”

With the new metrics, the PMO has greater visibility and more control over the development process. “They’re better able to quantify the time spent on higher priority, tier-one break-fix support and on development,” says Garvey.

The Strategic Advantages

As a result of the new infrastructure, the PMO team gained a top-down view of the project and portfolio levels. “They can immediately see the progress of a particular project at any given time,” says Garvey. “It is easier than ever to identify statuses, blockers and dependencies, pending items, and who’s working on what.”

“The teams now have the information they need to estimate and complete work based on their current teams’ available capacity,” says Garvey. “This also helps them determine if they need to augment staff to achieve strategic goals. Leveraging the enhanced functionality of Advanced Roadmaps and Structure, the PMO is now setting more accurate timelines and providing their executive sponsors with more meaningful information.”

Ready for the Future

“Overall, it was a highly collaborative process,” says Garvey. “We worked closely with the head of the PMO and the company’s executive stakeholders to realize their vision and assist them with their tooling decisions and design.”

Even with the new infrastructure in place, it is just the beginning for this medical claims provider. “They have everything they need to embrace an agile mindset and achieve an agile delivery method,” says Garvey. “Our executive sponsors extended the engagement several times and, as they move forward, Cprime is prepared to help the company complete their transformation.”

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Drew Garvey
Enterprise Solutions Architect

Drew is an Enterprise Solutions Architect with over 8 years of Strategic Consulting Experience and over 15 years of Technical Leadership Experience. His passion is to work with small, medium, and enterprise teams to define, optimize, and realize their tooling solutions and provide them the best outcomes possible.

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