Digital Health Insurance Provider in Telemedicine

Posted by Encora on May 24, 2023 2:30:20 PM
Encora’s approach drove significant improvements across the client’s eCommerce KPI dashboard.

Topics: Quality Engineering, Innovation Ideation, Appian, DevSecOps, Healthcare & Life Sciences, Innovation Roadmap Creation 

Industry Context

Appian is a low-code platform that allows users to create custom applications rapidly and simply. This makes it an ideal solution for a quick implementation of a new Ticketing Application for claims processing 

A robust Ticketing Application can streamline the claims processing and improve customer satisfaction by providing a central location for customers to submit and track their claims. 

Here are some of the benefits of using Appian to create a Ticketing Application for claims processing: 

  • Speed – Appian creates custom applications quickly and easily 
  • Efficiency – Appian can automate tasks like assigning claims to the right departments, notifying customers of claims status etc. This improves efficiency and reduces costs 
  • Customer Satisfaction – A more efficient and user-friendly Ticketing Application with Appian improves customer experience 
OH2 Industry

Client Challenge

The client is a health insurance company headquartered in New York, specializing in telemedicine, healthcare focused technological interfaces, and transparent claims pricing systems. 

The client’s existing customer service portal for claims processing lacked sufficient configurability and customization. The users had no control over their business requests and had to rely on IT teams for any issue that may arise. The portal was not user-friendly, the layout was cluttered and confusing, and it was not tailored to the specific needs of end users. This led to frustration and delays in processing claims. 

The client was thus looking to build a centralized Ticketing Application for their enterprise system that can enable end users to configure & customize the information they can collect and report on. The client wanted an application that can integrate with other systems and pull together data into one UI.

OH2 Challenge


  • A comprehensive Application Roadmap developed for desired functionality. Requirement gathering done by collaborating with multiple stakeholders involved. Identified the specific business goals, desired features, workflows, user roles, integrations, and reporting requirements​. Application Design was created considering the user experience, data model, process flows, and integrations 
  • Application Development to develop a flexible, scalable, and agile Ticketing Application. Appropriate data models were created with Appian's data modeling capabilities. Developed user-friendly interfaces for ticket submission, tracking, and management with Appian's drag-and-drop interface design tools assured stability, and reliability through Performance Testing, and User Acceptance Testing done with Appian's built-in testing framework​ 
  • Enhanced the DevOps process and reduced the risk of errors with Appian’s 'Compare and Deploy' feature​ 
  • Digital Transformation with user-friendly interfaces, self-service capabilities, real-time updates, and notifications 

OH2 Approach

Why Appian?

  • Speed  Appian applications can be built and deployed faster than the traditional methods
  • Scalability – Appian applications can be easily modified and updated to accommodate new requirements
  • Flexibility  Appian enables creation of custom applications for every business need
  • Integration  Appian allows integration of existing systems and data sources, making it easier to manage complex workflows and processes
  • Security  Appian offers robust authentication and access controls for protection from unauthorized access and data breaches
  • Collaboration  Appian's built-in collaboration tool allows multiple users to collaborate to build applications more efficiently, improving productivity and reducing the risk of errors

Frame 422

Appian Solution

  • The client’s existing customer service portal lacked sufficient configurability and customization
  • The client was looking to build a centralized Ticketing Application that can enable end users to configure & customize the information they can collect and report on
  • Encora partnered with the client to design and develop a robust, flexible, and user-centric Ticketing Application with Appian’s low-code platform
Primary Appian Services/Features: UI Patterns and Components, Compare & Deploy Process Automation, Data Fabric, Process Model Design for Actions, Record Level Security, Integration with Emails.
Frame 421


  • The Compliance team is kept organized by the ability to create new ticket types and include instructions for each ticket. The robust Ticketing Application enabled efficient management of customer issues, inquiries, and support requests. Improved customer engagement with guided ticketing journey and taking the guesswork out of the ticketing experience with real-time notifications 
  • The client onboarded 5 new teams that previously did not have any robust process in place into the ticketing app and have seen a drastic improvement in their productivity​ 
  • 10% reduction in end-to-end process time for tasks performed in the ticketing app compared to the previous customer service portal​ 
  • Increase in control over the Case  Flow configuration by 76% 
  • With a focused ticket list and the ability to create appropriate tickets easily, the client witnessed an increase in time saved of 52% 
OH2  Results
OH2 metric +76%

Case flow control

OH2 metric +52%

Cycle Time