New York Health Insurer: Transforming Telemedicine Service Delivery Through Innovative Ticketing Application

New York Health Insurer:

Transforming Telemedicine Service Delivery Through Innovative Ticketing Application

Industry: Healthcare & Life Sciences

Delivery Center: South America, Mexico, and Costa Rica

Industry Context

Telemedicine adoption has skyrocketed, pushing digital health insurers to overhaul claims systems designed for in-person care. To keep pace with new care models, insurers require solutions that digitize user experiences. Legacy systems not only constrain innovation but demand months of custom coding workarounds. In this climate, insurers are turning to modern platforms that help accelerate transformation via intuitive visual design, and reusable, components and condense months of development into weeks. This newfound agility bridges capability gaps without intensive coding and grants insurers the adaptability to remain customer focused. As virtual care becomes mainstream, digital health insurers must rapidly reinvent systems on the fly to deliver next-generation healthcare experiences and meet evolving expectations.

Digital Health Insurance Provider in Telemedicine -Approach

Client Challenge

Our client, a New York health insurer specializing in telemedicine, grappled with delivering streamlined experiences, and transparency across disparate portals and rigid legacy systems. Clunky interfaces frustrated users and caused delays. With no way to customize the end-user experience, reliance on IT for every issue was extremely high. The client aimed to develop a centralized ticketing application to empower end users to configure, and customize information collection and reporting. By aggregating relevant data into one intuitive interface, they sought to remove complexity, and boost transparency. As consumer expectations and telehealth services continued to evolve, the insurer needed a new platform to enhance experiences autonomously and bridge capability gaps without extensive coding or IT dependence.

Approach

Encora shaped a detailed application roadmap and design by conducting requirement-gathering sessions with critical stakeholders. We identified Appian as the low code platform of choice for its rapid application development, scalability, seamless integration, robust security, and built-in collaboration tools. We rapidly developed the ticketing application aligned to the client's specific requirements through:

Product Management: Identified the specific business goals, desired features, workflows, user roles, integrations, and reporting requirements and developed an application roadmap to achieve the desired functionality.
Product Development: Developed Our flexible and scalable ticketing application uses an agile approach to meet the client’s identified requirements.
Data Integration & Security: Integration with an external MySQL database helps connect the ticketing application to existing data sources and IT infrastructure.
CX Transformation: User-friendly interfaces developed with self-service capabilities, real-time updates, and notifications enable an intuitive and engaging user experience.
DevSecOps Strategy & Planning: Enhanced the DevOps process, and reduced the risk of errors with Appian’s ’Compare and Deploy’ feature.
Test Strategy & Planning: Unit testing, Performance Testing, and User Acceptance Testing were done with Appian's built-in testing framework.
Application & Product Maintenance: Ongoing success is ensured through application performance monitoring, which also addresses user feedback and implements enhancements and updates as required.

Appian Services

UI Patterns and Components

Compare & Deploy

Data Fabric

Process Model Design for Actions

Record Level Security

Integration with Emails

Results

The client onboarded five new teams with robust processes into the ticketing app and witnessed a drastic improvement in their productivity. The new ticketing application also reduced errors, boosted scalability and flexibility, and addressed ongoing challenges with clunky interfaces and poor user experience. Compared to the previous customer service portal, there has been a major reduction in end-to-end process time for tasks performed in the ticketing app. Additionally, it has:

Streamlined provider onboarding, cutting down time, and labor costs. Each business unit can now manage its own workflows, allowing for the rapid streamlining of processes such as Complaints & Grievances, Find a doctor, and Clinical Review.
Consolidated disjointed legacy systems into a unified portal with a simplified interface.
Boosted transparency by aggregating relevant data into customized reporting.
Enabled autonomous configurability so users did not need IT ticket requests.
Adapted experiences rapidly via a drag-and-drop environment.
Reduced user frustration and increased engagement through guided ticketing.