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BCBSRI :: Business Process Modeling

Health Payor Blue Cross Blue Shield of RI needed to comply with new regulations introduced by Obamacare which impacted their, individual, large group,and Medicare books of business. The new regulations require BCBSRI to modify and update their health plan estimation processes so that individuals and companies could obtain real-time health coverage quotes both on the BCBCRI web site as well HealthSourceRI – the state operated health insurance connector platform.

As part of this initiative, BCBSRI also wanted to improve controls surrounding their large-group, self insured customers which typically comprises municipalities and large enterprises that offer different plan coverage to their staff such as executive, employee, and retiree. Due to the nature of these plan groups, changes in benefit coverages are frequent and without a comprehensive control mechanism, it would be virtually impossible to track and bill for the plan modifications and administrational changes.

End-to-End Process
Policy Estimation | Rating
Salesforce.com Sales UI

The first step was to document the end-to-end process of new plan and existing plan creation and implementation – an extraordinarily complex set of processes that touches seven different business units from sales, through fiduciary and legal, claim trend analytics, and finally to finance and billing.

To succeed in this critical step, it was necessary to bring key stakeholders from each business unit together to three day-long analysis tanks. A continuous three feet high band of  of paper was mounted to the walls of the conference and as each stakeholder discussed the activities and interactions with other units, the steps, decisions, and information transfers were mapped onto the paper. On conclusion of the analysis tanks, the information gathered was captured in Visual Paradigm using it Business Process Modeling toolset.

The first two image above illustrate the complexity and depth on which the process details were documented, the third image depicts the sales team user interface that was developed and implemented in Salesforce.com

Project Details

  • Customer:
  • Category:
  • Skills:
    Business Architecture, Business Process Modeling, Salesforce.com
  • Date:
    July 30, 2013

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