Case Study · Healthcare payer
Modernizing Claims Processing for a Healthcare Plan Administrator
A three-year engagement migrating a regional health plan administrator onto a modern payer platform: converting the .NET claims applications, re-engineering the SQL Server database and automating HIPAA-compliant data exchange with national provider networks.
- Client
- A New England health plan administrator
- Industry
- Healthcare payer
- Our role
- Engineering partner
- Duration
- 3 years
The challenge
A New England health plan administrator was moving its claims operation onto a commercial healthcare payer platform. The work touched everything that keeps claims flowing: the .NET applications that process and adjudicate medical, dental and Medicare-related claims, the SQL Server database behind them, and the data exchanges that connect the plan with employers, carriers and national provider networks.
All of it had to move without interrupting claims processing, without compromising data integrity, and in strict compliance with HIPAA.
What we did
Working as the engineering partner on the program, SunAge:
- Defined requirements with stakeholders for the platform implementation and the SQL Server database migration, translating business and compliance needs into a technical plan.
- Architected and led the conversion of multiple .NET/C# applications that support claims processing and adjudication across medical, dental and Medicare-related lines of business.
- Re-engineered the database layer, migrating and optimizing stored procedures for the new platform’s SQL Server database while enforcing data integrity standards.
- Managed the data migration, moving historical and operational data with validation at every stage.
- Automated critical data exchanges, scheduling reconciliation, eligibility and X12 834 (enrollment) and 835 (remittance) files, and optimizing load times to support national provider networks.
The outcome
- Claims applications running on the modern platform, with the plan’s processing logic preserved.
- Faster, automated file exchanges replacing manual handling, with HIPAA compliance built into every step.
- A cleaner, optimized database layer that the client’s team can maintain and extend.
- A three-year partnership spanning requirements, architecture, delivery and cutover.
