Solutions: COBOL Development for Claims Processing

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One of the world’s largest health insurance corporation is composed of a set of companies that provides a full range of health insurance services globally, extensive employee benefit coverage, and provider member health services. Due to challenges with quality, and timeliness, the company decided to bring a development team in house to modernize their claim submission and processing.

Purpose

The current Mainframes COBOL environment was highly customized in order to support all claims practice areas within the organization, and could not be easily adopted by other teams. Hence they are in the process of modernizing their backhand services, such as IMNU, Benefit determination whose process are in COBOL as well as in java. This very large and complex application is a set of java based frameworks modernizing the claims processing, price determination, and benefit determination for members and providers. Contracts are all handled in this packaged set of services.

Process

Solving IT assisted by placing a senior-level Java application architect to round out the claims technology team with the maintenance and enhancement of these services. In his first thirteen months, he has undertaken several projects related to integrations between JAVA based services of multiple applications and COBOL based mainframe systems of IMNU.  ClaimsGUI is another java based team which forms the front end of the services used by claim representatives to submit a claim. Due to slow development times, non-uniform coding practices, and preparation for future scalability and flexibility of the existing claim processing environment, the modernization project required more than 24 months to achieve its goal.

Additional contributions include:

  • Created services from CTF perspective assisting the claims GUI project, thus ensuring that IMNU Mainframe systems will no longer be in use.
  • Integration of these services with CLAIMS GUI and ensuring they call COBOL programs necessary.
  • Implemented BDD Java cucumber, in addition to JUNIT testing an enhancement introduced for the first time.

Results

Because of the way these services were developed, they have taken some of the load off the current system and will allow claim representatives the flexibility to submit a claim using claims GUI, as well as IMNU. The enhancements made will also provide more flexibility for the system to be adopted by other practice areas throughout the organization. The creation of a BDD based unit testing has increased the speed of developing projects. The implementation of the BDD unit testing has also increased the quality of business rules written by business analysts. Synchronized with the code written by developers, it resulted in a more uniform development approach that was in tune with the business requirements written by business analysts.

The introduction of the BDD in terms of development was introduced by the Solving IT consultant thus ensuring BDD CUCUMBER gherkhin is used in the organization. The Business Analysts have started writing business requirements in GHERKHIN language the language of the feature files of the BDD framework thus making a change in approach of writing business requirements in projects moving forward.