Business Process Automation for a Health Insurance Litigation Company
From manual processes to scalable automation—
transforming claims management and dispute resolution.
- Scalable Operations
Expanded from manual bottlenecks to enterprise-wide automation
- Faster Case Turnaround
Quicker dispute resolution with streamlined workflows
- Higher Accuracy
Proprietary rules engine improved pricing precision
- Improved Client Experience
Better claim outcomes and increased satisfaction
About the Client
Our client is a leading consulting firm specializing in health insurance litigation. They help providers and patients resolve disputes with or without law firms, applying proprietary rules and methodologies to establish fair pricing for services provided by physicians and hospitals.
The Challenge
Over time, the client developed effective proprietary rules and methodologies, but their application was highly manual. This created significant constraints:
- Limited number of cases could be processed simultaneously.
- Long turnaround times for disputes and claims
- Inefficient claim. management and reporting.
- Difficulty scaling operations to new states and handling increased data volumes.
The client needed a secure, scalable, and automated solution to manage growing demand while maintaining accuracy and compliance.
The Solution
Partnered with the client to design and deliver a modular, Microsoft Azure-based platform that unified data, workflows, and business processes.
Key capabilities included:
- Active Directory-based authentication for secure access
- Master Data Management for clients, providers, and physicians
- Proprietary Rules Engine to apply pricing logic consistently
- Automated Document Generation for detailed and summarized outputs
- Calculation Sheets & Charts generated automatically for transparency
- High-volume Processing of over 5 billion CMS data rows
Our Process
We applied Agile methodologies to deliver the solution incrementally:
- Defined Epics, Features, and Stories in Microsoft DevOps
- Daily standups, bi-weekly sprints, and backlog reviews ensured transparency
- Weekly demos gave the client constant visibility and the ability to adapt priorities
This collaborative, iterative approach allowed us to deliver value quickly while aligning with evolving business needs
Technology Stack
- Azure App Services – Microservices in C#.NET
- Azure SQL Server & SQL Server Database – Core data management
- Azure Logic Apps & Data Factory – Data integration from CMS to app DB
- Power BI – Reporting and analytics
- Angular 6 – Modern front-end interface
- Azure Active Directory – Secure authentication and access control
- Office 365 & OneDrive – Document storage and collaboration
The first version was delivered in just 6 months, with ongoing development, refinements, and support continuing today.
The Results
Our solution transformed the client’s operations:
- Faster case turnaround, improving dispute resolution timelines
- Better claims management and more accurate disbursement
- Higher client satisfaction through reliable outcomes
- Pricing accuracy improvements via the rules engine
- Scalable operations, supporting expansion into additional states
- Data-driven insights through advanced reporting and analytics
- Quick adaptability to new regulatory standards and requirements
Why It Worked
The project succeeded because of:
- Close client collaboration – Weekly reviews and demos kept delivery aligned.
- Agile execution – Incremental delivery-built trust and reduced risk.
- Automation-first focus – Eliminated manual bottlenecks in high-impact areas.
- Future-ready design – Azure-based modular architecture ensured security, scalability, and compliance.
Through this engagement, we didn’t just automate workflows—we gave our client the foundation to scale nationally, improve accuracy, and deliver better outcomes for providers and patients alike.
