How One SMB Processes Thousands of Claims in Minutes with Serverless Computing

For small and medium businesses (SMBs), making the decision to modernize older technologies can unlock vast opportunities. Wisconsin, US-based technology firm VBA is a leading provider of comprehensive software solutions to the health insurance industry. They are a healthcare SMB and their flagship offering, VBASoftware, provides customers with secure and flexible claims processing in the cloud.

VBA recently initiated a transformation project with Amazon Web Services to help health plans improve back office administrative work. An automated claims adjudication engine (which automatically processes medical claims without requiring human interference) dramatically cut processing speeds—a major competitive advantage in their industry. It ultimately led to maximizing reliability, scalability, and cost-effectiveness for their customers. AWS talked with VBA Software Architect, Matt Salerno, about the company’s serverless cloud journey.

Harnessing cloud computing for scale and innovation

Over the last 12 years, VBA established itself as a top provider of cloud-based claims and benefits administration software. To grow their business capabilities, initially the company rented virtual computer space through Amazon Elastic Compute Cloud (EC2) rather than in-house servers. “We needed a scalable solution for servers, without going out and procuring hardware because we were a small company, and it was pay-as-you-go with EC2,” Salerno explained. “It was a really fast way to scale up our business.”

Following a phase of rapid growth, VBA began setting more ambitious goals. “I teamed up with VBA CTO, Rich Pierce, to look at our architecture, to see what we could do to help us get to the next level,” he said. “How can we get tenfold from where we are right now?” VBA decided that, by expanding their use of AWS, they would be able to modernize their technology and target higher levels of scalability, flexibility, and workflow efficiency.

Working with AWS to stay ahead of the curve

VBA identified opportunities to improve customer experience and began their analysis with the desired end result, a process they had learned in a Working Backwards workshop with the AWS account team. The workshop applies Amazon’s unique innovation process to help businesses like VBA understand their customers’ problems first and develop a solution from that starting point.

“We went through the whole [process]—identify your customer; identify what their main problem is through the lens of that customer and the different perspectives that they have; and walk through the whole journey of our customers to find the problems that they face,” Salerno said.

Ultimately, VBA decided to innovate their automated claims adjudication engine with AWS serverless computing services.

Developing leading-edge technology solutions for an SMB in the cloud

As a leading provider of claims adjudication services, VBA processes hundreds of thousands of healthcare claims every day on behalf of its customers. After extensively evaluating other options, VBA decided that even more benefits could be unlocked by rebuilding their adjudication engine as an event-triggered serverless system based in AWS Lambda.

“We wanted to find a new architecture to really scale—not only scale up to meet our claims volume, but also be cost-effective,” Salerno explained. “With Lambda, you only pay for the run time, so when it sits idle, you’re not paying for it. Total cost of ownership was super important to us.” These business benefits appealed to non-technical leaders at VBA.

If you identify a technical leader, you might be interested to know how it worked. VBA developed a new highly efficient and scalable system that uses AWS Lambda and state machines. Their serverless event mechanism for triggering claims-processing workflows is managed through Amazon EventBridge and Amazon Simple Storage Service, while Amazon CloudWatch and Amazon OpenSearch Service were also implemented in order to monitor and optimize the system’s performance. This new architecture has eliminated the need for dedicated servers, allowing for on-demand parallel processing.

Raising the bar for claims-processing software

For VBA’s customers, the new VBAdjudication system promises to deliver massively enhanced processing speed and practically infinite scalability. “By using this, our parallel processing is through the roof now,” Salerno explained. Testing and quality assurance for VBAdjudication has successfully processed queues of 60,000 claims—which used to take hours—in just minutes. “When we tell people we can do this volume in just minutes, it’s totally blowing the minds of everybody in the industry,” he said. Since the scalability involved is not linear—adjudicating queues of 120,000 claims would also take mere minutes—the new system’s future potential is sky-high.

VBA is now confident that they offer the fastest claims auto-adjudication speeds in the industry. User feedback during the beta testing phase has been overwhelmingly positive, with customers also responding well to improved scalability and VBAdjudication’s ability to process claims through APIs. VBA’s health plan clients can expect to see major enhancements to their claims-processing workflows and an enhanced overall customer experience.

By modernizing and redesigning their adjudications engine, VBA have gained a major advantage against enterprise-grade competition, which enables them to attract larger health plan clients. Thanks to an innovative application of AWS Cloud computing technology, this healthcare SMB is successfully establishing itself as a disruptive industry leader.

Next steps

By collaborating with AWS on a serverless cloud architecture, VBA has been able to offer leading-edge claims-processing solutions to their customers. Curious if any of the processes or services above might work for your business? You can contact us to continue your healthcare SMB’s move into the cloud.