Insurance orgs are diversified and their operation involves covering various needs of human life ,business and society. It is data intensive, time critical and utmost risk sensitive. Now a days many complex home grown custom apps, integrated with 3rd party products and many feeds coming in from the field. In such a distributed environment, it is difficult to isolate performance issues.
Providing an exceptional online customer experience and litigation free is the top most priority. On one end, there will be consumers; on the other side, there will be agents, dealers, agencies/hospitals, banks and aggregators. When various operators are involved in Proposal Entry, Underwriting, Claims settlement, a small delay in the process chain will have a huge impact on business performances .
When the business teams worry about the above questions, the IT Infrastructure team has its own set of questions to satisfy..
Every piece of the insurance application must interact well and fast, to achieve these goals.
Resileo can monitor all components of your insurance application and ensure a great experience in performance to the customers.
Claims process in most of the Health Insurance firms follows either cashless or through reimbursement process. Claim can happen from registered hospitals or from non registered hospitals. Registered hospitals include hospitals that are approved by the Insurance Company for processing the intimations on behalf of the insurer. For all the non registered hospitals, insurer has to go through the reimbursement mode to complete the claim process. Let us understand how it works in the health insurance sector.
General processes for the claim are as follows
Cashless claim is performed within a timeline of 20 to 30 min from the time it is initiated and mostly all the process are automated. Cashless is only possible with the registered hospitals
Cashless claim process is initiated by Hospitals directly into the portal of the insurance Company and it is expected that more than 1000s of hospitals do this claim at any point of time with many insurance companies. This means the performance of the servers and the connectivity supported to each of the hospitals play critical role to ensure the insurance claim process is efficient and effective.
The above process is very critical as the diagnosis is dependent on the approval of the intimation from insurance for the hospital to proceed. Any delay here, might lead to chaos and confusion leading to patient dissatisfaction. Most importantly the trust within the customer gets reinforced, only when the supporting online system responds faster.
As soon as the claim intimation gets generated it has to go through certain pre defined activities within the system like
All the above must happen within short time (most of insurance Company claim this to happen within 20min from the time intimation is created in the system)
Once the intimation goes through first level of acceptance, then before the payment is being made to the insurer, following activities are done by the hospital or through the service agent of the insurance company, once the procedure is over on the patient and before getting discharged from hospital.
Once the approval is sent, the Insurance Company takes that intimation for payment process as per agreed terms.
With the above process, it is very important the server is capable of doing multiple activities with various checks in place. System requires to be tested with 1000s of claim initiated from various hospitals to understand the real capability and try to understand hardware performance, code performance for the generated load. With the actual performance testing it is possible to arrive at the stress point, and analyze the code for further optimization.
If it is not tested, there is every possibility that we might oversize the hardware without any valid reason. It is proven in various industries; by doing the performance testing, for the most used business transactions and optimizing the code based on the result, resulted in reduction of 50% or more of the estimated hardware cost.
With the load testing, it is also possible to arrive at the threshold values of certain critical performance counters. Continuous monitoring allows the ops team to take the right decision well before the hazardous situation happens.