HCL develops a Fraud Case Management System (FCMS) for the New York State Insurance Department (NY

SID)

BACKGROUND
NY SID is responsible for supervising and regulating all insurance business in New York State. The departments long-standing commitment is to combat insurance frauds through its Insurance Frauds Bureau (IFB) NY SID approached HCL to help it replace its existing systems with a new workflow based, web enabled system with enhanced features on newer technology

CHALLENGES / OBJECTIVES
NY SID currently experiences the following business challenges: Difficulty in Fraud Case Investigation Tracking & Disposition of Fraud Cases Existing processes are manual and involve a lot of paper work, which is time consuming and inefficient The process of leveraging the recouping of funds as an outcome of the misuse of benefits is complicated Automation of investigation processes Providing up-to-date information to keep pace with the future needs of the department was a demanding task

SNAPSHOT
Vertical: Public Services Micro-vertical: Government Service Areas: Application / Solution
Development & Maintenance

Technologies: Java/J2EE, Oracle 10g

database, BEA Web-logic Application Server 8.1, Handy soft BizFlow 10.1 BPM, Crystal Reports X IPs / Frameworks: iGOVERN - Fraud Case Management System

THE SOLUTION
HCL automated the process by replacing the current mainframe based system and provided enhanced functionality and features to enable the Bureau manage its operations. NY SID required a web-based true workflow system to automate its various functions such as IFB/complaints intake, case development, case closure & update, and issue & payment of civil fines HCL enhanced the web-enabled Fraud Case Management &Tracking framework to enable fraud case investigation tracking and the disposition of these cases Provided single sign-on, portal integration and ADS integration, and handled the Complaints Intake process for external users who submitted complaints remotely Provided event chronology with Code Validation Rule Engine (CVRE), Milestone and Case Disposition record maintenance Provided multilevel approval capabilities based on the organization hierarchy Provided cross-referencing capabilities both at case and referral (complaints) levels, investigation reporting and case file printing Referred cases to other agencies like AG, DG, OGC; automatic case assignments and maintaining evidence details Letter generation (warrants, communication with other agencies, appointments, etc.) and maintaining the original copy of referrals/complaints submitted by external and remote users Provided capabilities for attaching files and other documents at case level and complaints/referral levels; case notes, comments and descriptive investigative reporting; alert notification and deadlines

RESULTS / BENEFITS
Remote submission of complaints; real-time workflow implementation and routing of complaints to Unit Supervisors Printing the entire case with complete data in a single PDF and maintaining electronic attachments online Automatic validation of adjudication events and the business rule during investigation Generating statistical reports for management decision making Generating letter and document templates, acknowledgement letters and batch printing of complaints Faster investigation; real time alerts to users on pending work and deadlines Faster and accurate dynamic cross referencing of subjects in other complaints Workflow enabled multi-level approvals of the Case Close process

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