Regulatory scope
PIPEDA · Canada Revenue Agency · Alberta Revenue Agency · province-specific regulatory policies · HIPAA-aligned controls
Multi-Payer Claims Adjudication, Rebuilt from Desktop Monolith to Microservices
Quikcard, Canada's leading health benefits provider, ran its entire claim lifecycle - initiation, adjudication, settlement, payment and reporting - on a desktop application bound to an Oracle database. Seasia rebuilt it as a cloud-ready microservices platform handling multi-payer operations across Wellness, Health, Vision and Drug programs, with a configurable rules engine, automated payments and AI-assisted claim triage.
Overview
INDUSTRY
Health Insurance / Healthcare Payer
Geography
7 years, ongoing
The Health Management System is an enterprise healthcare management and insurance automation platform that digitizes the complete claims and revenue cycle lifecycle. It enables multi-payer operations with payer-specific rules, credentialing, eligibility validation and settlement logic, supporting both employer-sponsored and government-backed benefit plans including low-income and adult claims.
The platform delivers end-to-end claims processing from initiation and adjudication through settlement and payment across Wellness, Health, Vision and Drug programs, and provides real-time visibility into claims status, funding, payer responses and settlement outcomes.
Overview
The Health Management System is an enterprise healthcare management and insurance automation platform that digitizes the complete claims and revenue cycle lifecycle. It enables multi-payer operations with payer-specific rules, credentialing, eligibility validation and settlement logic, supporting both employer-sponsored and government-backed benefit plans including low-income and adult claims.
The platform delivers end-to-end claims processing from initiation and adjudication through settlement and payment across Wellness, Health, Vision and Drug programs, and provides real-time visibility into claims status, funding, payer responses and settlement outcomes.
INDUSTRY
Health Insurance / Healthcare Payer
Geography
7 years, ongoing
Project Scope & Business Challenges
The client needed to modernize a tightly coupled claims platform that handled the full lifecycle from initiation through settlement and payment.
Key challenges included:
A Desktop Monolith Carrying The Entire Claim Lifecycle.
- A thick client bound to Oracle handled initiation, cardholder administration, adjudication, settlement and payment. Every change touched everything; scaling meant scaling the whole application.
Multi-Payer Benefit Logic With No Service Boundaries.
- The platform administers Wellness, Health, Vision and Drug programs across multiple payers, each with its own fee guides, pricing caps and provincial rules. That logic sat inside the monolith, making new payer and plan launches slow and regression prone.
Modernization Without Interrupting Settlement.
- Claims settlement runs continuously, and money moves through it. The migration could not create a processing gap, and financial records had to reconcile exactly across old and new systems throughout.
Solution Offered by Seasia
Seasia re-architected the platform into independently deployable services aligned with key claims and financial workflows. Modernization introduced configurable rules, automated adjudication, secure payment processing, and centralized payer administration while preserving continuity across legacy and modernized components.
Monolith decomposition
Decomposed into bounded services aligned to the claim lifecycle – initiation, cardholder management, adjudication, settlement, payments and administration – replacing a single deployable with independently releasable services.
Spring Boot microservices
Services built on Java and Spring Boot with REST APIs, JWT security, API Gateway and service discovery, cloud-ready by design.
Configurable rules engine
Rule-based adjudication driven by plan, payer, province and city-specific fee guides, with procedure code management, bulk imports, universal fee synchronization and pricing-cap enforcement, so new plans are configured rather than coded.
Real-time adjudication and settlement
Automated claim validation, adjudication and settlement with copayment, coinsurance and deductible calculation, plus multi-payer and government low-income and adult claim processing.
Payments and financial operations
End-to-end cheque and EFT processing with secure banking integrations, ledger management, adjustments, cost codes, tax calculations, EB and OCL processing, and payer-level payables visibility through centralized dashboards.
Payer management and credentialing
Centralized payer onboarding and configuration, payer-specific policy enforcement, multi-payer claim routing, real-time policy verification through EDI integrations, credential verification prior to claim submission, and secure payer data segregation.
Benefit and plan administration
Customer-specific benefit plan configuration across Wellness, Health, Vision and Drug, with plan-level pricing caps, utilization limits, benefit allocation by card type, on-the-go plan updates and change request tracking.
Intelligent claims optimization
Predictive fraud detection and anomaly identification with automated claim triage and AI-assisted prioritization, reducing denial rates and accelerating settlement cycles.
Modernized reporting and dashboards
Payer-wise claims and settlement dashboards, claims turnaround and reimbursement tracking, funding visibility, benefit utilization insights and compliance-ready audit reports, replacing the legacy reporting stack.
Angular portal and mobile extensions
The desktop UI rebuilt as a responsive browser portal with mobile extensions, removing per-workstation installation and enabling claims submission from web and mobile.
Oracle 10 to Oracle 19c upgrade
Data layer upgraded with optimized data models, retaining Oracle as system of record to avoid a simultaneous platform and database change.
Our Tech Stack
The platform was structured using a scalable, secure, and integration-ready technology stack suitable for fintech, retail, and payment workflows.
Backend
Java
SpringSpring Boot
REST APIsJPA
MavenArchitecture
MicroservicesAPI Gateway
service discovery
JWT securityFrontend
Angular web portalmobile extensions
Database
Oracle 19cmigrated from Oracle 10plus SQL
Backend
JavaSpringSpring BootREST APIsJPA
MavenArchitecture
MicroservicesAPI Gateway
service discovery
JWT securityFrontend
Angular web portalmobile extensions
Database
Oracle 19cmigrated from Oracle 10plus SQL
Compliance & Security
The platform was structured with a scalable, secure, and integration-ready technology stack suitable for fintech, retail, and payment workflows.
Safeguards
JWT authentication, credential-based access control for payer workflows, secure payer data segregation, audit-ready logging of payer actions and decisions, encryption of data
Data handling
Secure data handling with enterprise-grade controls; role-based access, audit logging and data traceability for regulatory reporting
Delivery standards
ISO 27001
CMMI Level 5
Features & Outcomes Delivered
The modernized platform brought claims, benefits, payer administration, financial operations, analytics, and automation into a more modular operating model. It reduced manual intervention across the claim lifecycle while giving administrators greater control over payer rules, pricing, settlement, and platform performance.
Claims Processing & Adjudication
- Claim initiation and digital submission
- Real-time claim validation, adjudication and settlement
- Rules-based approval with copayment, coinsurance and deductible calculation
- Multi-payer and government low-income and adult claim processing
- Automated claim triage with AI-assisted prioritization
Benefits, Pricing & Plan Administration
- Configurable fee guides by plan, payer, province and city
- Procedure code management, bulk import and universal fee synchronisation
- Benefit and plan administration across Wellness, Health, Vision and Drug
- Plan-level pricing caps, utilization limits and benefit allocation by card type
Payer Management & Eligibility
- Payer onboarding, routing and policy enforcement
- Payer credentialing and eligibility validation
Payments & Financial Operations
- Cheque and EFT processing with banking integration
- Ledger management, adjustments, cost codes and tax calculation
- Payer-wise claims, settlement, and funding dashboards
AI, Fraud Detection & Operational Intelligence
- Predictive fraud detection and anomaly identification
- Automated claim triage with AI-assisted prioritization
- Payer-wise claims, settlement and funding dashboards
Digital Experience & Quality Engineering
- Automated functional, API and database regression suit
Results
The full insurance claim lifecycle digitized into a paperless claims platform
Real-time adjudication replacing manual, error-prone settlement
Automated workflows cutting settlement delays
Predictive fraud detection and AI-assisted triage running against live claims
Multi-payer scale supported for large enterprises and SMBs on one platform
A centralized portal for reporting, enrolment, funding and financial management
Claims submission available through both web application and mobile app
Unified dashboards giving business stakeholders detailed real-time visibility
A 7-year transformation from legacy desktop to next-generation platform, completed without interrupting live settlement
Modernizing a Claims platform?
Seasia helps insurers and healthcare organizations modernize legacy claims systems with modular architecture, configurable rules, automated adjudication, and integrated financial workflows.
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