Building a Customer Facing HIPAA-Compliant Health Insurance Marketplace with Payment Processing on Odoo

Overview

Novobi utilized the flexibility of Odoo Community to deliver a custom health insurance marketplace to enable agents to provide quotes and onboard customers in addition to a customer-facing payment portal.

The Client

INDUSTRY:

Health care, Insurance

LOCATION:

Texas, United States

North American Health Care Plans (NAHP)

North American Health Plans is provided exclusively by North American Life Plans, a national independent insurance marketing organization. The company supports a network of more than a thousand agents in customer acquisition on an online healthcare marketplace. NAHP is an innovative health insurance service that provides comprehensive coverage at 30% to 50% less than traditional marketplace plans with the freedom to see any doctor, any hospital, anywhere.

NAHP allows individuals to access affordable, supplemental health insurance through their marketplace. Someone seeking health insurance is connected to an agent who finds a quote from available carriers. They are enrolled, payment is processed, and the agent receives a commission on the sale from the carrier.

Challenge #1

NAHP’s marketplace and sales model including quote generation, carrier integration and payment processing is not directly supported by Odoo applications

Solution

Build a custom system on Odoo Community combining the functionality of multiple applications with unique development

Challenge #2

Customer self-service portions are not available requiring more agent resources and manual functions for the onboarding process

Solution

Develop a robust marketplace where customers and agents are enabled to find, enroll, and pay for the right plans with automated workflows

Challenge #3

Migrating to HIPAA-compliant hosting is tedious, difficult, and expensive

Solution

Architect a cost-effective and HIPAA compliant solution on AWS and deploy rapidly

“The team at Novobi has exceeded our expectation, delivering an elevated level of expertise needed to scale our infrastructure and providing innovative solutions. Their experience with back-end, as well as customer interfaces, enables our team to quickly deploy business solutions.”

 

– Paul Andries | IT Director, NAHP

The Client’s Challenge

While NAHP’s customer enrollment workflow seemed straightforward, the legacy process required a number of delicate and complicated tasks. Growth had been challenging due to decentralized, manual, and inconsistent processes the company had in place. With a network of agents supporting customer acquisition, quote generation, and on-boarding, it became clear that manual processes for managing and tracking the customer journey and agent commissions were not scalable. In addition, limited ability to provide customer self-service meant on-boarding and relationship maintenance had to be handled by agents entirely in time consuming processes.

Customer and Agent Marketplace

Marketplace model is not supported by any existing applications in Odoo

NAHP’s business model required numerous manual processes throughout the customer journey in terms of acquisition, intake of pertinent customer information for the quotation process, sourcing quotes from carriers, filing legal documents, and processing payment among many other things. These tedious processes in the legacy system were almost entirely manual for the agents and could not be done quickly in real time.

In addition, having no support for customer self-service, portions of the workflow that could be handled by the end customer were not available. Considering the numerous moving parts for the process, regulatory implications, and workflows that were unique to NAHP, it became apparent that no single Odoo application would provide the necessary support to deliver the solution that would allow them to scale.

Integration with Carriers

Real time quotes from carriers are not supported

With limited integration to insurance carries, the process of sourcing a quotation in real time for a customer was not supported. This meant that following information intake, an agent would have to source and compare multiple quotes from various carriers to determine the best option for a customer. This manual process was time consuming and added additional steps to a process that required balancing multiple parties.

HIPAA Compliant Architecture

Manual tracking of agent commissions is not scalable

The highly complex and regulated insurance industry creates a number of challenges for scale, the largest of which is requirements for HIPAA compliant data storage and transfer. HIPAA compliance for companies operating online historically relied on dedicated servers which come at a high cost. Though AWS began offering more affordable compliant options in 2017, the process of migration is often tedious, expensive and time consuming. The combination of prohibitively expensive secure hosting as well as manual legacy processes hindered the client’s ability to scale quickly and effectively in a growing market.

“We are impressed with their project, risk, and budget management capabilities. They provide industry-leading project tracking and reporting, appropriate for large scale implementation while minimizing bureaucracy when necessary. Ha and his team communicate clearly and proactively. I would confidently recommend them. “

 

– Paul Andries | IT Director, NAHP

Novobi’s Solution 

As part of a larger engagement with NAHP that included a custom built agent commission management tool, Novobi engineered a health insurance marketplace with full HIPAA compliance, a robust CRM, payment gateway, carrier integration, and other enhancements. Novobi built upon the open source framework of Odoo, an enterprise software platform that can be expanded with custom feature development aligned to the unique needs of the client. Development encompassed 3 key features for a powerful, single solution.

A Health Insurance Marketplace for Agents and Customers to Work Together

Novobi combined customer quotes, on-boarding, payment, and maintenance processes into a platform that acts as a robust CRM. Application development included a portal for agents to create and save customer information to help generate quotes for coverage from several partner insurance carriers in real time without paperwork, phone calls, or waiting. This automated integration created efficiencies in the quotation process.

Payments, both one-time and recurring are securely handled online with full PCI compliance. In addition, legal documents, personal identifying information, and health information is securely transferred and stored in HIPAA compliant processes. Customers can provide this information securely in the platform without needing to interface with an agent directly, automating on-boarding processes that used to be manual.

Automating Processes with Customer Self Service

In order to open an additional sales channel for the client, Novobi’s build scope included a self-service customer portal allowing individuals to create accounts, request quotes themselves, and input any necessary data such as health and payment information securely and privately.

New contacts are automatically populated in the database and assigned to agents to handle going forward. Self-service allows customers to not only enroll on their own terms, but keep their profiles updated without agent intervention.

Combing Odoo and AWS to Deliver a Rapid, HIPAA Compliant Enterprise solution

The most essential portion of the Novobi build scope was standing up the client’s applications and database on HIPAA compliant AWS servers. The first phase of application development spanned 10 weeks to deployment.

In addition to fully secure hosting at greater cost savings than traditional dedicated servers, the AWS framework also supports rapid scale and centralized maintenance. Novobi recommended and applied best practices in hosting and data transfer and delivered fully.

“Novobi’s experience with back-end, as well as customer interfaces enables our team to quickly deploy business solutions. We are impressed with their project, risk, and budget management capabilities. They provide industry-leading project tracking and reporting, appropriate for large scale implementation while minimizing bureaucracy when necessary.”

 

– Paul Andries | IT Director, NAHP

The Novobi Approach

Novobi follows a strict implementation schedule following CMMI and Scrum frameworks with weekly sprints, ensuring that clients can expect demos and workable solutions weekly or biweekly. Novobi also follow best practices in configuration and customization to ensure the system functions correctly and protects client’s intellectual property. This approach makes it easier and more cost-effective to upgrade in the future.

Discovery

Planning

Implementation

Launch

Training

Support

Discovery

Novobi and NAHP spent many hours meeting to understand the intricacies of the business’ customer onboarding workflows. The discussions mainly focused on understanding manual processes and bottlenecks for collecting customer information, processing payment, comparing quotes, and other workflows.

Planning

A Novobi solution architect with a data science background worked with the client to design the database architecture and solution architecture to support the automated commission system.

Implementation

Because the system’s requirements are complex, Novobi couldn’t fully leverage any pre-built solutions. The developers needed to code all the custom fields, data, and logic from the ground up. Novobi also prepared an extended period for system and regression testing before going live.

Novobi sent NAHP the list of changes (release notes) and a detailed testing guideline weekly requesting feedback and to flag any feature as failed/passed. The development took a year to complete.

Launch

Go-live proceeded with no downtime, however Novobi took adequate time to ensure that the system rolled out without significant issues. Novobi quickly corrected any issues with fringe circumstances including slight projection miscalculation to ensure proper function moving forward.

Training

Novobi’s team worked with two key users at NAHP. Throughout the project, they provided the inputs and participated in system testing. Because of their involvement during development, they understood the solution by the time the system launched. They then provided training for the other users in their company.

Support

Novobi has provided ongoing support through online meetings to troubleshoot issues and releases updates when bugs are found and fixed.

Novobi's Methodology & Certifications

The Results  

Novobi was tasked with building a modern, powerful enterprise software platform to replace legacy systems and processes. By combining software with cloud-based technology and data analytics, they created an innovative, efficient, and most importantly scalable solution for the client.

Easier Customer Management

With a custom marketplace application

With a custom built marketplace combining Odoo functionality with specialized workflows, NAHP is able to manage their customer relationships, information, and payments in one place.

 

Save Resource Time and Energy

With customer self service

With a customer self service portal, NAHP is able to collect pertinent customer data in a secure manner without tedious back and fourth between agents and insurance carriers.

Secure Operations

With HIPAA-compliant hosting

By migrating to HIPAA-compliant AWS servers, NAHP was able to preserve legacy data while standing up a new system on cost effective, scalable infrastructure.

Want to Learn More?

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