Digital software platform to Staff Health Insurance

Digital Health Insurance Platform Development

I require a digital software platform to manage staff health insurance. The platform should have the following features:

- Claims management
- Online enrollment
- Wellness program integration

At the minimum, the solution should
• allow participants to submit medical claims electronically using a web portal and a mobile app
• capture claims, including direct-payment claims (claims paid directly to HCP)
• maintain insured person data such as personal details, coverage information, dependents, bank accounts and addresses
• maintain reimbursement rules (benefits)
• maintain health care provider data, including their bank accounts and addresses, and any agreements
• automatically adjudicate claims (validate and compute)
• process payment transactions to participants and health care providers
• generate reports and attestations
• provide secure workflow for medical adviser approval
• compute and process After Service Health Insurance (ASHI) contributions
• allow data exchanges with other WHO systems (Workday (HQ and all regions) and SAP (IARC)), HCPs, TPAs and other partners’ networks

Desirable features include, but not limited to,
• Built-in service ticketing system
• OCR and RPA capabilities to automatically extract data from scanned documents and invoices
• AI-supported adjudication process
• Stronger fraud detection mechanisms (AI-supported as well)
• Insured Person–centric UI/UX
• Electronic Health Information Exchange (HIE) capability with health care providers


The preferred platform for this project is both web and mobile app. I need the project to be completed as soon as possible, within a month at the latest.

Skills and experience needed for this job include:

- Proficiency in web-based and mobile app development
- Experience in creating digital insurance platforms
- Knowledge of claims management systems and integration with wellness programs.