Our client, a claims processing organization, wanted SplendidCRM (an open source CRM package that they were using to manage their day-to-day functioning) customized to meet their unique business requirements. To achieve this they teamed up with Icreon. We made several enhancements to the SplendidCRM application thereby enabling the client to manage their business process in a more effective manner.

Customer Profile

Our client is a US based claims organization.

Business Requirements

Our client was using SplendidCRM as their back-office application to manage the process of processing and forwarding claims to insurance companies. However, in using the SplendidCRM application in their day-to-day work they felt that it lacked features typical to their area of work e.g. the invoices module did not cater to the types of services that they offered, no option for merging multiple case documents was available, multiple user roles were not available etc. To address these issues our client wanted several modifications and enhancements to be made to the SplendidCRM application.

A solution to manage the day-to-day functioning of a claims organization

Users:
The users of the system will be the employees of the company using the application. Access to the various modules of the application will be based on the roles assigned.

Solution:
In delivering the solution, Icreon built enhancements and integrated with various core modules of SplendidCRM. The workflow of the application was customized to reflect the workflow followed for processing insurance claims.

Some of the customizations made include:

File Module: One of the core modules of the application this module can be used to create and manage case files. Each case file is assigned by the administrator to a specific staff member who in turn is responsible for processing and forwarding the case to insurance companies. We have customized this module to cater to functionalities typical to claims processing. An additional role of an "assisting adjuster" has been provided for. In the absence of the staff member assigned to the case, the assisting adjuster can take over. To handle the case related documents in a better and more efficient manner, mail merge and PDF bundling (converting multiple documents to PDFs) features have been built into the module.

E-mail module: The e-mail module has been integrated with other modules of the application (notes, files etc), allowing users to directly use files/notes (from the module itself) as attachments. Each case has multiple documents which need to be sent out to various concerned parties. To ease the process of attaching such documents we have provided the facility to group/merge documents to a bundle. While sending out e-mails, the bundle can be attached instead attaching individual files thereby reducing the chances of a file being omitted. The option of saving a message as a draft has also been built into the module.

Invoices module: This module can be used to raise an invoice for services rendered. We have customized the module to allow for a case file to be associated with an invoice. Additionally, the options for adding line items that reflect the various types of services under claims processing has been provided. The types of taxes to be levied and their rates can also be managed by the administrators.

User Management: SplendidCRM provides for only a single level of users. We customized the application to enable multiple user roles and hierarchy levels. Three new user roles have been provided - Users, Call Center Liaisons and Assisting Adjusters. Users are customers who can access the application to view the progress of their case files. The customer cannot edit the details nor can they view the case files of other customers. The first time that a User logs into the system he/she can do so without using a password. The system will recognize the customer (on the basis of the e-mail id entered; it must the same as that on their case file) as a first time customer and will generate and send a password to her/him.

Assisting Adjusters are users who are assigned to a case in the absence of the originally assigned staff member.

Other Enhancements
In addition to the core modules mentioned above we have made the following changes to enhance the user experience:

• The breadcrumbs have been customized to cater to the claims processing workflow. Now when a user assigns a file to another user, the file will no longer be available in the breadcrumbs.
• New alerts have been added to the dashboard allowing the users to track new files created in the system, new bills raised etc.
• The Invoices quick search option has been customized to allow users to search for invoices on the basis of amount. Mathematical operators (such as >, <, = etc) can applied on the search criteria. The user has the option to save and apply the search criteria to the invoices section.
• We have customized the application to allow for bulk upload of documents.

Technologies used in developing this application are: