Problem Statement:

SideCarHealth, a health insurance provider, faced significant challenges in managing and updating their health pricing policies. Each quarter, they needed to update their health insurance contracts, which were maintained in complex Excel sheets. This process presented several issues:

1. Lengthy Policy Updates: Manually updating policy underwriting and premium calculations took 3-4 weeks, delaying the rollout of new health plans.
2. Dependence on Technical Staff: Reliance on their in-house tech team for routine policy adjustments diverted valuable resources from strategic initiatives.
3. Data Integration Challenges: Integrating Excel-based data with other healthcare systems and third-party services was cumbersome and prone to errors, impacting data accuracy and operational efficiency.
4. Regulatory Compliance Risks: Slow implementation of regulatory updates increased the risk of non-compliance with healthcare laws, potentially exposing the company to legal liabilities.

These challenges hindered SideCarHealth's ability to respond swiftly to market demands, optimize their policy offerings, and maintain compliance in the dynamic healthcare industry.

Solution:

By partnering with Nected’s low-code/no-code rule engine and workflow automation platform, SideCarHealth modernized its health insurance policy management, accelerated decision-making, and improved overall compliance. Leveraging Nected’s flexible integrations, formula editor, and secure architecture, they achieved the following:

Implementation in Less Than 1 Day:

1. Rapid Integration: Connected existing Excel-based policy data to Nected’s platform via no-code API connectors.
2. Immediate Rule Reconstruction: Rebuilt complex underwriting logic and premium calculations, cutting the previous 3–4 week timeline down to hours.

Empowered Business Teams:

1. No-Code Configurations: Enabled non-technical staff to define and modify underwriting criteria, rating factors, and benefit tiers without coding.
2. On-the-Fly Adjustments: Allowed real-time updates to reflect changing medical cost trends, regulatory shifts, or network contracts.

Seamless Data Integration:

1. Migration from Excel: Transitioned to a low-code/no-code database, ensuring consistent data accuracy.
2. Holistic Data View: Integrated policy attributes with enrollment data, claims records, and regulatory updates for comprehensive insights.

Operational Workload Reduced by 90%:

1. Automated Calculations: Used Nected’s formula editor to apply complex actuarial formulas, coverage algorithms, and geographic multipliers effortlessly.
2. Streamlined Workflows: Employed decision tables and automated pathways to handle eligibility checks, renewal triggers, and premium recalculations, freeing teams to focus on strategic initiatives.

Enhanced Compliance and Security:

1. Self-Hosted Deployment: Ensured sensitive health information remained secure and in compliance with healthcare regulations (e.g., HIPAA).
2. Robust Governance: Implemented role-based permissions, encryption, and audit trails to uphold data integrity and meet rigorous regulatory standards.

By leveraging both the rule and workflow features of Nected, SideCarHealth not only streamlined their policy management but also positioned themselves to scale efficiently while maintaining compliance with industry standards.

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