Sky Solutions

Revolutionizing Claims Management with Digital Modernization

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Overview

A state-level workers’ compensation commission wanted to modernize its claims management process using automated technologies. It selected Bizagi, a sophisticated BPM Commercial Off-The-Shelf (COTS) tool to achieve this. Sky Solutions collaborated with the government, PMO contractor and Bizagi to perform systems integration and modernization, replacing outdated and poorly integrated legacy systems.

Goal

The primary goal of the project was to enhance the overall claims service experience for both internal and external users.

Challenge

The client encountered several challenges, including slow claims processing times, cumbersome legacy systems, and insufficient integration across different operations. These issues led to inefficient claims intakes, prolonged processing times for hearings and appeals, and delays in settlements, which adversely impacted the service experience for the citizens of the state.

Solution

To effectively address these challenges, Sky Solutions focused on several key strategic initiatives, including:

  • Establishing a robust technological foundation that not only supports innovative applications but enhances system performance
  • Applying a systematic approach to optimize processes and improve overall efficiency
  • Establishing protocols to ensure rapid issue resolution with defined response time targets
  • Migrating legacy claims and user data to a more advanced platform, improving accessibility and service delivery
  • Introducing advanced reporting tools to improve decision-making and transparency
  • Implementing a new system to streamline document handling and retrieval

Technologies/Methodologies

  • Bizagi
  • Power BI
  • Azure B2C
  • Azure Active
  • Agile
  • SQL Server
  • SharePoint
  • FileNet
  • Low-Code/ No code

Outcome

The solution enhanced the overall claims experience for both internal and external users through seamless integration of various systems and modernization of legacy components, ensuring a more cohesive and user-friendly process. 

Some of the key outcomes:
  • Claim Intake Processing Time: Reduced from 1–2 days to just 30 minutes, significantly accelerating case initiation.
  • Hearing Issues Processing: Cut turnaround time from 5–7 days to approximately 10 minutes, enabling near real-time resolution.
  • Appeals Handling: Reduced processing time from an entire day to under 2 minutes, dramatically improving responsiveness.
  • Settlement Finalization: Shortened settlement completion from 2–3 days to nearly 1 minute, enabling same-session closure.
  • Requests for Continuance: Reduced handling time from 2–3 days to about 3 minutes, eliminating administrative backlogs.