Modernizing Healthcare Claims Processing with Scalable, Event-Driven Architecture

3 Minutes

Modernizing Healthcare Claims Processing with Scalable, Event-Driven Architecture

John David

A fast-growing healthcare technology solutions provider was looking to re-engineer their traditional claims processing solution with a modern technology stack, improving performance, maintainability, and scalability while enabling seamless multi-tenant support. Additionally, the architecture was not optimized for cloud deployment, which led to operational inefficiencies.

Client: Healthcare Technology

Services: App Modernization

Year: 2025

Project Objectives

  • Redevelop the existing solution using a modern technology stack to enhance performance and scalability.
  • Develop an optimized Master List Transmission system to enable accurate and efficient handling of large healthcare data sets.
  • Streamline the Product Transmission process to ensure seamless data flow across multiple systems.
  • Automate the Global Update module to enhance scalability and reduce errors in large-scale updates.
  • Improve compliance with industry standards and regulations while enhancing overall system reliability.

Technologies Used

Solution & Implementation

  • The existing solution was redesigned and implemented using .NET Core for backend development, ensuring a scalable and high-performance system. 
  • The entire solution was rewritten to improve code maintainability, reduce technical debt, and ensure long-term scalability.
  • Transitioned from an on-premise infrastructure to a cloud-based solution, leveraging the benefits of scalability, security, and high availability.
  • Implemented an event-driven architecture to enhance system responsiveness and improve data processing speed.
  • Developed an efficient transmission system that enables accurate and timely updates of master lists, reducing processing delays and improving data integrity.
  • Designed and implemented a streamlined transmission module that ensures seamless product data transfer across different systems, minimizing manual interventions.
  • Automated large-scale updates across multiple systems, reducing errors and enhancing operational efficiency.
  • Ensured adherence to industry standards such as HIPAA by implementing robust security measures and encryption protocols.

Outcomes

  • The redesigned system now efficiently supports multiple healthcare providers in a cloud-based environment.
  • The transmission process run-time that previously took around 100 hours for 30,000 products is now completed within a couple of hours.
  • Moving to the cloud and reducing manual interventions led to cost savings and resource optimization.
    Reduced manual effort through automated translation and transmission pipelines.

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