Business Need
Heritage TPA needed a faster, more reliable, and fully traceable way to verify medical claims in the field and cut down on fraudulent payouts. Their teams relied on emails, phone calls, paper notes, and disconnected tools, resulting in slow investigations, inconsistent evidence, and limited auditability. With over 300 field investigators operating across geographies, they required a modern mobile solution that could streamline onsite visits, provide geotagged evidence, and create a single source of truth.
Field verification relied on emails, calls, and handwritten notes; evidence was difficult to track or authenticate.
No real proof of onsite presence, enabling fraudulent claims to slip through.
Media, documents, and report formats were inconsistent across teams.
Audits were time-consuming due to scattered data.
The legacy SQL Server setup limited scale and modern UI/UX capabilities.
Faramond designed and delivered a modern Investigation Application built on Oracle APEX, backed by Oracle Database and OCI Object Storage, with mobile access on both iOS and Android. The system introduced end-to-end digital field verification with geotagging, guided checklists, structured workflows, and secure evidence handling.
Geotagged check-in/check-out with GPS coordinates and timestamps to verify onsite presence.
Guided checklists for different claim types to standardize the investigation process.
Media and evidence capture including photos, documents, and field notes with metadata.
Case severity management, SLA-based routing, escalation logic, and automated red-flag identification.
Supervisor console for reviewing findings, approving audits, and monitoring field teams.
Dashboards for productivity, TAT, fraud patterns, and geo-based heatmaps
End-to-end audit trail to ensure compliance and traceability.
Discovery workshops to map workflows, red-flags, fraud scenarios, SLAs, and field processes.
Migration from SQL Server to Oracle Database on OCI using a secure landing zone.
APEX application build comprising field app + supervisor console
Structured pilot, UAT, refinements, and nationwide rollout.
Runbook preparation and ongoing monitoring to ensure operational continuity.
Faster Decisions – Field evidence delivered in minutes instead of days, enabling quicker claim approvals.
Fraud Reduction – Geotagged check-ins and secure metadata significantly reduced false claims.
Operational Clarity – Unified source of data ensured complete auditability and standardized reporting.
Higher Productivity – Field investigators saved time, and supervisors gained visibility across regions.
Mobile/Web → Oracle APEX on OCI → Oracle Database
OCI Object Storage for secure media & evidence
Centralized reporting and audit framework
