2019 Winner Profile

CareFirst BlueCross BlueShield

Project Description:
The Service Benefit Plan Administrative Service Corporation (SBPASC) provides IT operations and services to 35 BlueCross and BlueShield plans that, in turn, offer health-insurance benefits to 5.4 million federal employees nationwide. The NextGen program's goals are to modernize claims-processing systems, provide customer-service representatives an integrated platform with a 360-view of members, and increase operational efficiency. The company leveraged agile and enterprise DevOps for the first time nationally to deliver these features, which include a new BI tool for operational reporting, a BPM engine for claims inventory workflow management, a benefit and code management tool to configure benefits and products, an expanded rules engine to manage claims edits, and an expanded API management tool to support web services. One Blue Cross plan reported that the platform has freed up almost 2 hours a day of supervisor time, and another said it has reduced the number of deferred claims by 60%.
Business Goal:
Operational Impact
William Byrd
Kimberly Petty
Washington, DC
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