Case Study

Establishing and Managing a Testing Center of Excellence (CoE)

About the Company

Our client is a leading healthcare payer organization with operations spanning 15 states, specialized in Medicaid, Medicare, and Marketplace insurance programs. With over $1 billion in revenue and a workforce exceeding 7,000 employees, the client plays a critical role in the U.S. Healthcare system. Their focus on delivering highquality care to their customers demanded a robust testing framework to ensure the seamless and secure implementation of new technologies and services.

Background of the Business Problem

The client faced significant challenges in managing the complexities of healthcare systems, especially in maintaining application performance, securing sensitive data, and meeting diverse regulatory requirements. The specific challenges included:
  • Quality Assurance: Ensuring consistent quality across the development lifecycle for various healthcare applications, while simultaneously overseeing the smooth integration of new solutions.
  • Security Vulnerabilities: Protecting sensitive patient data and preventing breaches, ensuring adherence to HIPAA and other regulatory standards.
  • Application Performance: Optimizing applications under high-traffic conditions, especially during open enrollment periods, which often resulted in service slowdowns or failures.
  • Automated Testing: Implementing automation to reduce manual intervention, improve efficiency, and ensure high-quality releases within short timeframes.
  • EDI (Electronic Data Interchange) Management: Ensuring seamless EDI processes for various healthcare transactions, which are critical for claims and billing workflows.
  • Regulatory Compliance: Ensuring that all systems met strict healthcare regulations, including adherence to state and federal mandates.
  • Accessibility and Localization: Enhancing applications to meet ADA, WCAG and diverse regional healthcare needs, making them accessible to all users across the client’s wide reach.

Our Approach & Solution

To address these challenges, we established a Testing Center of Excellence (CoE) in 2 Quarters, leveraging cutting-edge tools and practices to transform the client’s testing landscape. Our approach included:

Predictive Insights & Automation

Implemented data analytics to predict issues and automated customer support using Salesforce Einstein Bots.

End-to-End Automation

Developed 20,000+ automated test scripts, reducing human error and accelerating testing for QNXT platform upgrades.

Governance & Optimization

Established strong governance for specialized testing, optimizing shared resources and test coverage.

Shift Left/Right Testing

Applied shift left for early non-functional testing and shift right for postproduction monitoring and continuous improvement.

Automated Regression & DevOps Integration

Enhanced regression testing automation and integrated testing into DevOps pipelines with custom check gates for faster releases.

Architecture Modernization

Upgraded infrastructure with Azure, .NET, Sitecore, and Pega for improved scalability and performance.

Reusable Data & BI Components

Created reusable data warehouse and BI components to streamline data processing and analytics.

Business Outcomes

The transformation resulted in significant improvements across multiple areas, leading to both short-term wins and long-term value for the client:

Cost and Efficiency Improvements

  • Achieved a 25% cost reduction by adopting a Core-Flex resource model.
  • Reduced operational costs by 45% through process automation using Robotic Process Automation (RPA).

Performance Enhancements

  • Improved claim processing efficiency by 40%, reducing the time taken for reimbursements.
  • Enhanced application performance by 70% with cloud integration.

Automation and Testing

  • Rolled out intelligent automation solutions, significantly improving the testing process.
  • Developed over 20,000 test scripts for QNXT upgrades, ensuring smoother deployment cycles.

Reliability and Adjudication

  • Increased system reliability by 30% and auto-adjudication by 68%, ensuring fewer manual interventions in the claims process.

Support and Testing

  • Provided seamless support and testing services for over 100 applications, ensuring continuous improvement and smooth operations for all key systems.

Conclusion

The Testing Center of Excellence established by Infinite helped the client not only meet their immediate goals but also set them up for long-term success. The client can now confidently manage their application landscape, provide secure and seamless experiences for their customers, and handle the growing demands of the healthcare industry. The transformation paved the way for enhanced operational efficiency, improved service reliability, and increased customer satisfaction.
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