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Automating Business Processes for a Healthcare Services Provider

Healthcare | Application Development

A healthcare services provider sought to transition its legacy mainframe architecture to a microservice enterprise architecture in order to automate and enhance claims and ordering processes. Based on our proven staffing track record, the client partnered with TEKsystems’ Application Development practice to support their automation efforts.

Through its subsidiaries of eye care businesses, the client provides eye care plans, eyewear products and services, and ophthalmic technology. The nonprofit vision company conducts an extensive range of activities within the optical industry, including creating merchandising systems; designing, manufacturing and distributing eyewear; and offering ophthalmic lens products and laboratory services.

Every organization looks for opportunities to reduce costs, and when it comes to IT, automation is an impactful approach to saving. The microservices software architecture consists of multifaceted applications that are made up of independent processes that talk to one another via language-agnostic application programming interfaces (APIs) and are centered on a small task. Microservices are easy to change, modify or replace, making these services compatible with a continuous delivery software development process. They are decoupled and structured around specific capabilities, such as billing or logistics. Instead of operating in silos, microservices are shared across multiple applications or a suite of different services; this helps reduce redundancies, eliminate duplication of work and better manage and maintain applications.

As opposed to relying on vendor-based, monolithic solutions, microservice architecture uses technology native to the Internet. This enables organizations to avoid paying expensive licensing fees for vendor-specific services.

For Web developers, microservices simplify their jobs and drive efficient use of time and energy. They streamline and accelerate application development processes and circumvent any potentially unnecessary work. Ultimately, implementing this type of architecture in place of legacy architecture enables organizations to decrease manual work, increase automation and generate cost savings.

Agile methodology, Apache Camel sub routing, Chef deployment, Continuous Integration (CI), Drools, Java version J2K 1.6, JBehave, Jenkins, JIRA, Microservices architecture, REST APIs, SOAP

The client, a healthcare services provider, was operating with an aging architecture that slowed business processes such as billing, orders and claims. The business processes were associated with its e-commerce platform and were manually managed. Specifically, they included:

  • Insurance claims submissions when benefits were applied to an order
  • Sending customer orders to the client’s internal order fulfillment systems

The lack of automation associated with these processes hindered the client’s time-to-market needs. In anticipation of a significant increase in order volume and the number of stores needing to share back-office capabilities, the client sought to transition away from its legacy architecture in favor of a microservice architecture. This initiative to automate insurance claims submissions and customer orders would enable the client to increase the efficiency of e-commerce processes, and improve and maintain those business processes; subsequently, this would help reduce human errors and improve overall business quality.

Reducing errors

The client had a high volume of incoming claim requests, and a team of representatives were responsible for importing that information into two different systems. Human error was inevitable, so managing that process and reducing those errors would be a major benefit of automation.

Improving quality

Additionally, the high-quality code introduced into the architecture during automation would help prevent issues in production. As a result, bugs and issues found in production—which were previously very time-intensive to resolve—would be prevented, limiting disruption to the process.

The prospect of automating these business processes offered quality, time and cost benefits. But if the client was unable to achieve that level of automation, there were a number of potential negative consequences, including performance issues with e-commerce fulfillment, employee morale issues due to increased workloads, and budget overruns associated with maintaining the manual processes.

While the client needed to initiate the insurance claims automation effort, they did not have qualified IT resources available in house who could develop the relevant advanced applications. Finding the right resources that were needed, such as senior Java developers and architects, posed a challenge; there was a nationwide shortage of strong Java resources, and quality assurance (QA) resources with JBehave and/or automated testing skills. Meanwhile, the demand for these difficult-to-reach skill sets was high.

The imbalanced supply-demand ratio was prevalent in every market, including in northern California, where the client is located. This meant that if they wanted to hire a strong Java developer, it would require a lot of time and money. Considering a team was needed, the time and cost would be compounded—a huge risk for the client. Time was a critical factor. The client had a short timeline and any extended time required to find the right people would be costly. As a provider of vision benefits, the client’s busy season is during the very end and beginning of each calendar year when members enroll in or change their benefit plans. During this period, the client must go into a code and system freeze where nothing goes into production. This timeline would dictate the transition away from the legacy architecture. The client wanted production to take place ahead of time so members could benefit from the improved features.

To initiate the automation effort, the client had one of three choices:

  1. Rely on internal IT teams to get the work done. This would prove to be difficult because their in-house team lacked the necessary skill sets required to get the job done, and they would be unable to attain the level of automation the client needed in time for the end-of-year spike.
  2. Augment their existing team by hiring outside resources. This was a high-risk option, given the national supply-demand issue surrounding the niche skill sets needed.
  3. Outsource the work to an IT staffing and services provider. Trusting a third party to dedicate their time to finding the right people would be the best option. This type of provider would offer the expertise and local market knowledge needed to know how to find, source and retain the best, most qualified talent for the job.

In order to transition the client away from its legacy mainframe architecture to a microservice enterprise architecture, the client required support from a third-party IT staffing and services provider. Having worked with TEKsystems in the past for staff augmentation, our Application Development practice proposed a solution for their automation initiative. We would assemble a team, including a delivery manager, project manager, technical architect, business analyst, development team lead, developers and a QA analyst. We would scale this team up or down as the project demanded.

There were several project risks we had to be mindful of:

Resourcing: The supply-demand issue pertaining to the skill sets the client needed was not limited to their local market or industry. TEKsystems would also need to be prepared for potential delays tied to sourcing these resources.

Test data: When running tests, it was important to test relevant, quality data. Without the proper test data, delays can occur. TEKsystems would need to be able to provide the right test data in a timely fashion. Having relevant test data ready would enable us to finish iterations faster, so we could in turn complete the testing and continue moving on to the next iteration.

Integration with existing systems: There would be risk involved in integrating with external services, as there would be an element of discovery. Considering there was little documentation or information about those services, TEKsystems would have to rely on other people getting back to us with the necessary information. Without fully understanding the previous architecture, there was a level of unpredictability. For example, providing an estimation would be a challenge because we lacked some insight and documentation. 

Having worked with TEKsystems in a staffing capacity in the past, the client trusted our capabilities and the skills and expertise of our team. We had access to resources with hard-to-find skills during a period of short supply. Our solution offered a near-shore team (Montreal) as opposed to purely off shore, which further differentiated our support, and TEKsystems was selected to deliver a solution.

TEKsystems’ Application Development practice successfully completed the insurance claims automation initiative, transitioning the outdated legacy architecture to a more automated architecture. Previously, the client had many manual processes that were dependent on an antiquated infrastructure. TEKsystems took those manual processes and built out a set of APIs for additional functionality and automation of several different customer services. For example, before when an order was placed on the client’s e-commerce website, a representative would manually post the order then also manually submit the claim for the member’s benefit. The process of submitting the order and submitting the claim was streamlined and automated after we finished that API with them.

Because of our success with the first project, we were able to grow our partnership and take on multiple different projects. And we have delivered on time and under budget with every project. The following table describes the various projects we have supported for this client.

 Sample Project  Descriptions
  Project 1. Automation of insurance claims submission when benefits are applied to an order; decreasing errors, increasing efficiency and improving quality
  Project 2. Automation of customer orders to the client’s internal order fulfillment systems; improving member benefits and time to market
  Project 3. Integration between client/member portal and the consumer/SAP back end
  Project 4. Conversion of business rules from ILOG to Drools
  Project 5. Identification and validation of active members; reporting on product usage

As a result of our support, the client realized greater scalability, flexibility and quality; more manageable maintenance; and reduced costs.

One of the notable risks for both the client and TEKsystems was finding the right people because of the shortage of IT talent with the skill sets required. With IT staffing expertise, we were able to mitigate that risk. Leveraging our proprietary Staffing Quality Process®, we were able to quickly source and retain the optimal IT professionals for the job. With access to a massive network of IT talent and over 100 offices in the U.S. and abroad, we had the ability to scale our support and tap other markets outside the client’s locale, such as in Montreal and Dallas. We also took the time to understand the client’s business, which enabled us to develop an employee value proposition to attract high performers with the skills required. Because of our established recruiting capabilities and expertise, the team has been stable since the initial project, and continues to grow. We started with just five resources and built the team to 15, and we anticipate it will grow to 20—signs of a healthy, high-quality team that the client is happy with.

Since the beginning of our services partnership, we have been able to help the client reduce costs. For example, as a result of our initial insurance claims automation project, TEKsystems supported the conversion of business rules from ILOG to Drools. ILOG has a high licensing fee while Drools is open source. If we did not get changes into production by the end of the year, the client would have had to pay a penalty or stay with ILOG for more time. Additionally, because the client is a provider of vision benefits, their busy season is during the end and beginning of each calendar year. We were able to get the business process automation changes into production in a short amount of time—just 12 weeks—so that it was ready for consumption during the busiest time of the year.


Prior to the first IT services project, the client worked with TEKsystems in a staffing capacity only. Once we were able to demonstrate our effectiveness and the quality of TEKsystems Global Services® and the Application Development practice specifically, the client trusted us with more work. Throughout the partnership, client stakeholders have been cooperative and engaged in our progress. To start, the team visited the client on site for a weeklong kickoff, and this face-to-face time helped make client stakeholders comfortable and confident in our capabilities. We have continued to grow and strengthen our partnership ever since.

The TEKsystems team

Over the course of our services partnership, we have provided high-quality IT resources. Our core team has remained stable for over a year, enabling us to ensure consistent delivery of service. Given the shortage of skill sets required, our ability to source and retain people with the right technical skills and ability to deliver on commitments proved critical to our success with this client.


In large part our success was due to our dedication to open communication with this client. We kept stakeholders informed of our progress with every project and activity, eliminating any potential surprises. For example, our delivery manager was responsible for frequently communicating overall engagement status, including regular status reports, with client management.