HCL developed a Fraud Case Management System (FCMS) for the New York State Insurance Department (NY SID) to help automate its fraud investigation and case management processes. The previous system was mainframe-based and did not provide necessary functionality. The new system implemented a web-based workflow system that automated intake, investigation, closure and other key processes. It provided benefits like remote complaint submission, real-time routing, cross-referencing, reporting and approvals. The system helped NY SID work more efficiently and effectively in combating insurance fraud.

4. 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 department’s 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
SNAPSHOT
NY SID currently experiences the following business challenges:  Vertical: Public Services
 Difficulty in Fraud Case Investigation Tracking & Disposition of Fraud Cases  Micro-vertical: Government
 Existing processes are manual and involve a lot of paper work, which is time  Service Areas: Application / Solution
consuming and inefficient Development & Maintenance
 The process of leveraging the recouping of funds as an outcome of the misuse  Technologies: Java/J2EE, Oracle 10g
of benefits is complicated database, BEA Web-logic Application Server
 Automation of investigation processes 8.1, Handy soft BizFlow 10.1 BPM, Crystal
 Providing up-to-date information to keep pace with the future needs of the Reports X
department was a demanding task  IPs / Frameworks: iGOVERN™ - Fraud Case
Management System

5. 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

6. Hello, I’m from HCL! We work behind the scenes, helping our customers to shift paradigms and start revolutions. We use digital engineering to
build superhuman capabilities. We make sure that the rate of progress far exceeds the price. And right now, 88,000 of us bright sparks are busy
developing solutions for 500 customers in 31 countries across the world.
How can I help you?
www.hcltech.com