Clerical streamliner

COMPANY: Christian Social Science
PURPOSE: To automate health insurance claims processing.

APPLICATION: Shark -- Until last year, Lucerne, Switzerland-based Christian Social Science (CSS), the second largest Swiss health insurance company, was processing claims the old fashioned way -- by hand. Although the 150 clerks in the processing center had access via CICS to a legacy mainframe Cobol system running a DB2 database, most of the work required checking rules in paper-based books and catalogs and crunching the numbers using pocket calculators.

In recent years, CSS management was finding more and more problems were arising from doing business the old-fashioned way. Clerks were prone to making errors. Because individuals read rules differently, there were inconsistencies in the way claims were processed. The duties of the clerks were becoming increasingly stressful and boring, resulting in higher turnover and thus causing escalating training and human resources costs. For the CSS customer base of physicians and hospitals, the system was slow. Processing a claim generally took between 20 and 30 days. Management concluded that the manual system was not up to the job, and quickly convinced the firm's board of directors to support the development of an object-oriented, client/server system designed to automate claims processing.

The CSS development team, led by project leader Stefan Scherrer, designed the new system, called Shark, using the methodologies of Grady Booch, author of Object-Oriented Analysis and Design, and Ian Graham, author of Object-Oriented Methods. The Booch method helps developers design systems using the object paradigm. The overall project was tracked and managed using Microsoft Project. The team members communicated among themselves and with vendors via E-mail using Microsoft Office and Netscape Navigator. The programming was done using the Sun Microsystems version of C++. Throughout the design and development process, key end users reviewed the system requirements and the prototypes.

The developers linked the client/server application to the legacy mainframe database using sockets. The team is now planning to enhance the connection by introducing a transaction and messaged-based Corba architecture to allow client/server applications to tap into CICS transactions.

Implementation of Shark began in 1997 and should be done by the year 2000. Already it is providing the insurance company with competitive advantages. Once received, claims, which were being processed in 20 to 30 days in the old manual system, are now completed in one day.

- Rich Seely


TEAM

STEFAN SCHERRER

PHILIPPE NUSSBAUM

HANSPETER WEBER

EDWIN STEINER

CHRISTOPH MURER

STEPHANE POLTORATZKY

PATRICK KAUFMANN

JÖRG BRÜNDLER

ELISE GACHET

(O2)--FROM O2

TECHNOLOGY

SYSTEM ENGINEERS

MARKUS STETTLER

URS TONAZZI

CHRISTINA KAISER




BENEFITS:
Claims are processed faster with fewer errors than manual system. Cost savings of 0.5% per claim for processing 18,000 claims per day is expected to be $25 million per year by Year 2000.

PLATFORMS:
Legacy Mainframe, DB2 and CICS; Server: Sun ES/4000, Sun Solaris 2.51; Clients: Sun SPARC workstations, O2

About the Author

Rich Seeley is Web Editor for Campus Technology.

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