Insurance Claim Process Managed and Monitored with Serverless360

In recent times cloud computing has played a significant role in various domains. In this blog, we will look at how Serverless360 helps these domains fulfill their business needs. We will explore a global insurance provider’s business need with regional offices in several territories and partners in many countries who need to manage policies and contracts and submit claims from different countries to the customer to reduce the processing overhead and maximize automation opportunities.

Business Solution

The business problem for this use case was to consolidate and centralize the processing of insurance claims into a new solution. The need is to provide a centralized source of truth for claims and centralized partner management followed by processing and then offload the claim to be handled locally by the regional office under additional local market rules. The solution would provide a single point of integration for partners who would work in multiple territories and centralized management of claims at the first point of contact.

Technical Solution

The technical solution for this project was to use Microsoft Dynamics and Power Platform eco-system as the heart of the solution for data management with integration from partners via multiple channels such as: 1. Azure API Management for API 2 .Microsoft Power Apps for manual entry by staff for paper claims 3. Microsoft Azure App Service for Partner Self Service Portal 4. Microsoft Logic Apps for EDI and cloud Integration The platform implementing this solution looked like the following diagram.

Technical Solution

While Dynamics and Power Platform form the core of the solution in terms of the system of record and engagement, Microsoft Azure provided the platform for the custom components needed for the main integrated parts of the system. The key to success for this solution was the integration story that made it easy for partners to integrate with the platform. The partners we would need to integrate with would have different technology capabilities ranging from small partners with minimal technology capability to big multi-national partners with advanced technology platforms. For those small low-tech partners, we provided options for the administrators to upload invoices via a Self-Service Portal as PDF or manual entry or to send paper invoices that our internal teams could process. We offered a range of options for other partners, such as integration via EDI style interfaces where messages or batches could be submitted, which were then processed via Logic Apps into the CRM system. Later, response batches would be returned. Some partners had API-based systems. We offered an API that allowed those partners to submit data via an API that could leverage Azure API Management, Azure Functions and Service Bus to process submissions and integrate them into the CRM system. With an extensive partner network and a wide range of technical capabilities, as a service provider, the ability to offer several different ways to integrate with the platform makes it accessible. It opens the opportunity to do business with all of the partners in the network. One of the aims would be to work with and encourage partners to move from the low-tech options to more automated approaches where possible, resulting in a more seamless experience and lower operating costs and quicker processing times. In the solution, the entry point via whichever channel data comes into the system would process claims by an engine developed with Azure Functions. This setup allowed more advanced and complex rules to be created that could be implemented with Dynamics core functionality. It also allowed us to optimize and control the processing as needed.

The Management & Monitoring Challenge

The implemented solution needed to address complex requirements, and Microsoft Azure and Microsoft Power Platforms provided an excellent technology platform to deliver the solutions. With over 300 Azure Resources making up the overall solution, the challenge is how to lower the support burden of the solution, so the support team can manage it without everyone needing to be an Azure expert and make the solution manage itself where possible. The management and monitoring challenge comes from multiple perspectives. There are challenges like management, monitoring and tracking of individual transactions being processed. Where are they, when did they get processed and are there errors. There are also questions like “is the system healthy” “have we had any downtime” and those technical and service level questions to answer too. The solution chose to include Serverless360 as a monitoring and operations portal so that we can allow safe and secure access to non-azure experts. Perform those level 1 and level 2 support operator tasks to maintain the system and allow business users who fall under the super users to manage business transactions.

Serverless360 Business Activity Monitoring

Serverless360 Business Activity Monitoring (BAM) is a crucial part of the solution. We implement BAM in the claims processing area when receiving thousands of claims per day and having many key background processes acting on the data received from partners. Serverless360 BAM can accept telemetry about business milestones from the technologies within the solution by performing distributed tracing. We created BAM processes to collect and return claims from partners and implemented BAM business processes covering background processes like the claims processing engine. With the claim processing engine, using BAM provides a business-friendly console that allows business users to track the status of claims that have been received and see where they are within the claims processing cycle. The business users can now self-serve on the integration solution to check claims status and deal with business process problems without escalating support tickets for many common data and validation issues. With the effective use of BAM, the number of support tickets to the IT help desk is a lot lower, and business users can identify, and handle issues experienced by partners quicker.

Serverless360 Business Applications

One of the critical challenges for a distributed solution is understanding how the distributed components work together to solve a business problem. With Serverless360 Business Applications, we can group those Azure resources which work together to solve a business problem. We grouped the specific Azure Functions, Service Bus Queues that make up our claim processing engine and the API’s and Logic Apps, which provide the different partner integration solutions. Serverless360’s Business Applications concept allows us to teach the support users how to manage each business solution and gives the support user least-privilege access to do the support actions we want them to do without needing the extensive experience of the entire Azure Portal and the risk that the support user accidentally does the wrong thing We can allow the support user to act on most day-to-day support-related scenarios with a basic understanding of Azure and focus on supporting our solution. Serverless360 Business Applications Proactive Monitoring Serverless360 Business Applications also allows us to create monitoring for the resources which make up the business solution. Serverless360 indicates when there might be a problem that affects the operation of the business processes. We can use features like Service Map to zone in on the area where the problem may be to get to a resolution quicker if there is an issue.

Summary

The net result of the Serverless360 application is that we have lowered the cost of support for our solution and provided our users with a better support experience by reducing the time to resolution for support cases with a significant reduction in the number of tickets that need escalation to the development team. The self-service aspects provided by Serverless360 BAM also inspire confidence in our solution for the business who feel engaged and have visibility of the health and workings of the system.

Originally published at https://www.serverless360.com/blog/insurance-claim-process-managed-and-monitored-with-serverless360