How HanseMerkur achieved an unimagined increase in efficiency through automated benefit accounting

More efficiency through automation, more time for complex cases

In practice, the project ranged from input management to the actual specialist process - consisting of the fee-based and tariff-based benefits check and benefits billing within the health benefits system - through to output management. The experts from the specialist area should only have to intervene manually in error situations or in particularly complex situations, whereby these are purely selective interventions after which the process is processed automatically.

In the first year of the project, the automation rate across all benefit statements was already increased from around 8% at the beginning to around 25% at the end - an excellent figure compared to the private health insurance sector. In order to not only maintain this rate, but to increase it even further, the process had to be designed flexibly for further optimization. Components that are sensibly designed in terms of responsibility and functional scope and geared towards the technical requirements lay the foundation for future adjustments. In addition, more extensive logging was introduced in conjunction with meaningful monitoring and reporting. The data obtained was the starting point for further steps in process optimization and thus a further increase in the automation rate.

The technological basis

The technological foundation and driving force was IT geared towards process and service orientation. Specifically, this meant the development and provision of a basic architecture and infrastructure and, building on this, the extensive replacement of the existing legacy system landscape with executable process descriptions, reusable components and services based on Java and centrally managed business rules.

A specially developed component registry enables the parallel operation of different versions of services, thus reducing dependencies and the effort required to adapt future changes. Comprehensive and meaningful dependency and IT portfolio management is required for the sustainable management of the components that have been created to date and those that will be created in the future. A central repository that records process and service models guarantees fast and clear access to the required artifacts. This would allow future change requests to be analyzed, evaluated and implemented more quickly and in a more informed manner.

Strong together: Business-IT alignment

Digitalization does not end with the use of the appropriate technology: An important step towards optimized processes and greater efficiency is also the use of an integrated, agile development process and close cooperation between the specialist departments and IT. This begins at the design stage and extends through implementation to automated technical acceptance testing.

The advantages are obvious: even during the design phase, the specialist departments began to think in terms of processes, services, responsibilities and contracts. On the basis of the resulting deeper understanding of the building blocks of the processes, it was subsequently much easier to appoint those responsible for the resulting components from the specialist departments.

The development of each module was concluded with an acceptance test using the FIT framework. On the one hand, this enables the repeated, automatic execution of all technical tests “at the push of a button” and, on the other hand, a strong involvement of the specialist departments in the concerns of automated testing. The technological mapping of complex tests in particular leads to an inflation of test cases that would no longer have been manageable with purely manual tests.

Success is a team effort

The integrated development process and the role model tailored to it were and are the basis for the project's success being seen and perceived for what it is - an outstanding joint effort by an interdisciplinary team.

I associate Holisticon not only with in-depth technological expertise, but also with the sustainable transfer of knowledge to our company and our internal employees.

Together, we were able to achieve and even exceed the goals we had set ourselves:

• Automation rate of already over 50% in the live operation of the overall process, equivalent to around 40 FTE clerks
• Significant relief for employees in the health benefits department
• Integration of automatic testing machines established on the market leads to greater uniformity in processing and significantly reduced average processing time

On a technical level, the restructuring of the previously monolithic IT system landscape was initiated and the rigid, heterogeneous systems, which did not allow for economic changeability and were not designed for automation, were broken up.

• Design and implementation of a basic architecture and infrastructure
• Flexible, automated processes that allow further optimization
• Development of centrally managed business rules and a component library for further automation and optimization

With the successful implementation of this digitalization project, HanseMerkur has taken an important step towards future viability and competitiveness.