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A rapidly expanding medical claims processor serving self-insured employers was struggling with a costly and ineffective custom-built platform. After spending $1 million and 18 months attempting to develop an internal solution, the company found itself with a system that lacked the flexibility, functionality and integration required to support its business model. The homegrown platform couldn’t keep pace with evolving operational demands and had led to a fractured ecosystem of disconnected systems and reporting tools.
Compounding the issue, the company’s outsourced financial systems provider was no longer able to support them, forcing a tight four-month timeline to select and implement a new accounting platform. They needed a partner who could step in quickly, evaluate the state of their existing investments and chart a new course—without compromising the speed of their business.
We were initially brought in to assess whether the existing custom platform could be salvaged. After a comprehensive and objective evaluation, we advised the client to abandon the system and instead laid out a new architecture that would better align with their growth trajectory. We quickly transitioned into a dual-track engagement: blueprinting a new claims platform while simultaneously selecting and implementing a new financial system—both under aggressive timelines.
The claims platform was rebuilt on Salesforce’s Force.com, a flexible and scalable framework that allowed for the development of highly customized business processes without the overhead of traditional custom coding. Key modules included claim intake, appeals, balance bill management, EDI and reporting. Integrated technologies such as FinancialForce, data.com, and SKUID further enhanced functionality and user experience. At the same time, we provided guidance and technical advocacy in selecting and standing up a new accounting system before year-end.
Our team completed the rebuild and deployment in just five months—less than a third of the time it took the internal team to produce an unusable system—at half the original cost.
The new platform enabled the company to scale from processing 25,000 claims per year to 25,000 claims per month, without adding headcount—thanks to automation, streamlined workflows and a fully integrated data environment. The solution also reduced reporting time and improved data accuracy by eliminating the need to manage siloed systems.
Over the next four years, the company grew its topline revenue 4X and increased bottom-line profitability by 25X, driven by operational efficiency and reduced dependency on manual processes. The modernized infrastructure positioned the business for multiple acquisitions and dramatically increased its valuation—empowering leadership with strategic control and the technical foundation to support continued growth.