Comprehensive Health Insurance TPA Software
Client is a service-based organization with offices in Hyderabad, New Delhi, Mumbai and branches across the country. It is in the business of providing third party administration services to Insurance companies into the domain of Health Insurance. ZAAX Consulting PL (ZCPL) would like to develop a comprehensive online software solution to automate its entire operations from collection of policies to underwriting, issuance of cards, claims processing, Accounts, CRM and performance monitoring. The objective of this software is to increase the efficiency of operations and to drastically cut down the response time to the policyholders as well as to the insurance companies and network hospital as these are the three basic and major entities in whole system.
The system is proposed to be built on Java Platform. This platform gives us the flexibility of speed, scalability, security, performance and allows for independence of hardware, CPU, platforms. Unlike .NET/Windows, JAVA platform does not have per user license issues and is not limited to specific operating systems. The system shall be developed using industry standard MVC architecture using a templating engine, a model, view and controller for each module and sub-module.
Oracle 11g is proposed as the database server.
Glassfish or JBoss proposed as the application server.
Intel or AMD 64bit hardware architecture is proposed.
The process starts with a contract entered with an Insurance company to provide third party administration services to its policyholders in a designated area. The contract can be with a new company for a designated area of operations or with an existing client for a new area. The Head office (HO) is the national headquarters of the insurance company. These insurance companies divide their geographical area of operations into regions, which are served by the Regional office (RO). Each regional office has a number of divisional offices (DO) under it. The divisional offices have a number of Branch offices (BO) or Direct agent branches (DAB) under it. Once the contract is signed with an insurance company the data related to the offices of the company within the specified territory assigned to ICare will be captured and maintained by the System Administrator. This will include:
- The contact details of the Head office of the company
- The contact details of the Regional offices that fall within the territory
- The contact details of the Divisional office within the territory
- The contact details of the Branch office and the Direct agent branches within the territory.