WynTec’s applications and knowledge-base are extensive and encompass the full spectrum of insurance and healthcare technologies. The team’s diverse experiences range from simple technology to implementation of large scale, multi-million dollar projects with national, international and multinational customers:

Worked with some of the largest national healthcare customers and direct vendor partners, establishing the governance, architecture, design, development lifecycle and deployment of healthcare, health delivery and health plan systems. Relationship included, but not limited to, Gambro Renal Care, Davita, Nation Wide, Independent Healthcare, Trinity Health, First Consulting Group, Computer Horizon, TEK Systems, University Wisconsin Healthcare, Unity Health Plan, AON Insurance.  

Numerous risk management consulting assignments for a variety of large customers which have included comprehensive review of all risk management functions and operations, workers’ compensation claim operations, safety management reviews, information technology reviews and needs analysis for liability programs, claim administration audits and programming services for medical-management reporting systems, MCO tracking system, HIPAA compliance, EDI payments, medical bills and data warehousing projects.

Total Outcomes Management Solution (“TOMS“) – design, development and implementation of proprietary data mart, data warehousing, and Ad-hoc & executive reporting solution (Total Outcomes Management Solution – “TOMS”) with outcomes focused measurement, benchmarking and vendor performance and assessment capabilities. This non-intrusive, low-cost solution has a built-in processing engine that integrates information across lines of insurance, business units, data elements and geographical areas. This application design has been deployed by insurance carriers, third party administrators, medical management entities, bill review processors, corporations, brokers, industry consultants and state funds. TOMS is also available under a Private Label Program.

E-Business Insurance Model (“EIM“) – system design, development, implementation and maintenance of an integrated eCommerce application (end-to-end transactions) for Property & Casualty and Health & Life insurance services. This application is deployed as an ASP model and includes modules for insurance carriers, agents, brokers, employers and consumers: plan details and coverage information, needs analysis, programmable scoring system, interactive Question & Answer session, real-time price configurator linked to an instant quote engine, integrated application forms and extensive office tools and resources incorporating on-line help guides, vocabulary and glossary terms. This also includes a defined contribution (self-direct) model for employers and employees that ties to Human Resource applications.

Analysis, design, development and implementation of system interface and application for a large Managed Care Organization (MCO). Conducted complete review of multiple installed systems, databases and compliance parameters for critical EDI transactions while insuring processing compliance, zero-tolerance for data-integrity issues, audit and control mechanisms and error reporting. This included the analysis, design, development, implementation, training and documentation of system interface and EDI applications including fully X12 compliant claim transactions – 148/s, 835, 837, 997 – and electronic funds transfer (EFT).

System design, development and on-going maintenance of an integrated managed care workers’ compensation system with related service products. This sophisticated transaction processing system linked claims managers, medical case managers and bill review analysts together around a common communication core and included the following fully integrated modules: early reporting, claims management (workers’ compensation, general liability, auto liability, STD and LTD), medical management, bill review management, litigation management, financial management, risk management and EDI processing.

Business process redesign and operations improvement based upon workflow analysis and system optimization. This included the management of a national, multi-line, integrated third party administrator (TPA) with 8 offices across multiple states with more than 350 employees. The integrated functions include workers’ compensation claims, general liability claims, claim reporting, absence management, medical management and bill review and extended to the conversion of claims and resources from other TPA’s and an in-house program without any interruption of services.

Analysis, design and implementation of extremely large data conversions. This data conversion, from multiple disparate systems, encompassed over $1 billion in payments and over 900,000 claims. The scope required the building of a fully operational staging data system where the data could be filtered and scrubbed while the complete system could be converted without any interruption of workflow or system downtime. This included balancing, reconciliation and data clean-up with knowledge-based defaults for data enhancement to the finished product.

Application development and facility management of bill provider clearinghouse. This included managing the facilities and bill review software between 50 certified organizations that provided medical services and the primary agency. The facility and application processed over 9 million medical bills annually with a “kick-out” rate of less than 5%. This project, one of the largest of its kind ever to be awarded, was delivered on-time and within budget.

International project experience with insurance, healthcare and managed care industry reform: the Canadian provinces of Ontario and British Columbia, the Republic of South Africa and Australasia.

We are considered experts in the construction and support of data warehouse applications for the insurance industry. The article, entitled, “Data Warehousing in Insurance: How Can It Work?” and co-authored by WynTec, was published in the September 2001 issue of Risk and Insurance Magazine and identifies the special needs of a proper outcomes focused solution for the insurance market. Our insurance experiences underscore our confidence in meeting and exceeding your expectations for your project needs.