Building a Compliant and Scalable Claims System

Overview of claims system project - a magnifier on a sheet of paper

Project Overview

Duration

8 months

Technologies

  • Java 21
  • AWS Lambda
  • Spring Boot 3
  • Amazon S3
  • SNS/SQS
  • RDS
  • ECS
  • React
  • TypeScript
  • Micro Frontend

The project aimed to develop a claims system that would streamline and standardise claim resolution for insured pets. Its core purpose was to equip claim handlers with a modern, compliant, and auditable tool for fair decision-making that would seamlessly fit into our client’s (NDA) existing insurance ecosystem.

Claims system project challenge - a lightbulb

Challenges

Domain Discovery: Even with solid insurance expertise, our client had always relied on third parties for claims handling. This marked their first venture into managing claims in-house as part of their value chain. Getting to grips with the domain’s intricacies, pinpointing critical subdomains, and setting up business rules presented a steep learning curve and called for a lot of teamwork and workshops to get right.

Tight Deadlines: The clock was ticking, with the MVP set to debut alongside a new product line. This required careful planning and execution at every step. Extended timelines or unexpected setbacks were out of the question as they could jeopardise the timeline.

Integration Requirements: The claims system needed to share data with both upstream and downstream systems, such as the sales platform and external third-party solutions, ensuring smooth and uninterrupted performance.

Security and Compliance: Right from the beginning, ensuring security and compliance was a top priority. The system had to safeguard sensitive data and fully adhere to industry regulations, leaving no room for error.

Incremental Delivery: What proved to be an ongoing challenge was gradually building the system while adapting to stakeholders’ evolving needs and expectations throughout the project.

Approach to claims system project - a hand with a lightbulb

Our Approach

We started the claims system project with event-storming sessions with subject-matter experts, including former claim handlers, to get a clear picture of the processes, rules, and subdomains. These sessions were pivotal here, as they allowed us to map out the entire claims lifecycle with plenty of expert input.

Our focus was on the “happy path” to quickly validate key assumptions while pushing edge cases to later stages of development.

In terms of our approach to delivery, we opted for a just-in-time modelling strategy. Thanks to this, we were able to build and refine the system incrementally. From day one, we started delivering features to production, using continuous feedback to shape and improve the system as we went.

When it came to architecture and integrations, flexibility was our top priority. To avoid premature data schema lock-in, we initially implemented an in-memory database and only moved to a full database once the domain model had stabilised and was close to the MVP release. For external API integrations, we used asynchronous messaging (SNS, SQS) where necessary to ensure smooth and efficient data exchange.

Security and compliance were front and centre throughout the project. We held non-functional requirements workshops and threat modelling sessions to address potential risks and define mitigation strategies. It was imperative that the solution implement role-based access control, detailed auditing, and comply with industry regulations right from the start. Working closely with stakeholders was a critical factor for the project’s success. We made sure to keep everything clear and transparent with visual tools like boards and delivery roadmaps. On top of that, we regularly ran demos and user acceptance testing (UAT) to keep stakeholders involved and ensure that the product met their needs.

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Effects

What results did our delivery of the scalable claims system bring to our client?

  • Enhanced efficiency and speed
    By automating workflows and integrating seamlessly with existing systems, the solution sped up claims processing, reduced errors, and freed up claim handlers to focus on decision-making rather than administrative tasks. This boosted productivity and helped our client handle more claims without needing extra staff.
  • Fair and compliant decision-making
    The system’s design made claim decisions transparent, easy to audit, and fully compliant, building trust with both policyholders and regulators through clear decision trails.
  • Successful market entry
    Delivering the MVP in sync with the launch of the new pet insurance product line allowed the client to hit the market on schedule and capitalise on new opportunities.
  • Future-ready flexibility
    The modular architecture and just-in-time data modelling allowed the system to evolve alongside business needs. This design enabled the client to address complex scenarios, introduce additional features, and meet new compliance requirements without significant rework. This approach reduced technical debt and long-term operational costs.
  • Stakeholder engagement and confidence
    Continuous feedback loops, regular demos, and early access to the system fostered strong stakeholder engagement. Decision-makers had direct input into the system’s design and functionality, increasing their confidence in its reliability and alignment with business goals.
  • Foundation for long-term value
    By capturing comprehensive data at launch, the system laid the groundwork for ongoing growth and innovation, such as advanced reporting, process automation, and new product offerings. 
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