Client Introduction
Crawford & Company (NYSE: CRD-A and CRD-B) is the world’s largest publicly listed independent provider of claims management and outsourcing solutions to the insurance industry, risk management community, and self-insured entities. Founded in Atlanta, Georgia in 1941, Crawford has grown into a global organisation with 700+ offices in 70+ countries. In fiscal year 2024, Crawford reported revenues of $1.3 billion, with its Broadspire TPA segment delivering a second consecutive year of record annual revenue.
Crawford’s capabilities span loss adjusting and claims management, third-party administration, medical management, business process outsourcing, and technology-enabled claims solutions. At the scale at which Crawford operates — processing complex claims data across multiple source systems, geographies, and lines of business — the reliability and accuracy of its claims data infrastructure is mission-critical. Crawford EDI Services is responsible for structured electronic exchange of claims data with vendors, partners, and regulatory bodies.
Project Introduction
Project Name: SCHIP Phase II – Claims Data Integration and EDI Delivery
Delivery Partner: Cognizant Technology Solutions
Role: Onsite Lead – Design, Analysis, Development, Testing, and Delivery
SCHIP Phase II is a strategic data integration project that extracts claims data from multiple heterogeneous source systems, transforms and validates it against reporting entity rules, matches it to reporting entities, and delivers structured XML output to Crawford’s EDI Services for vendor transmission.
Scope of work includes:
- Extraction of claims data from Mainframe, Oracle, and SQL Server claim administration systems
- Data transformation and cleansing prior to loading into the SCHIP SQL Server database
- Web UI configuration for loading reporting entity information and associated business rules
- Rule validation and SSIS package execution to match claims to reporting entities
- Mapping and conversion of matched claims data to Vendor XML format
- Delivery of XML files to Crawford EDI Services for vendor transmission
Solution Architecture: Five-Stage Pipeline
Stage 1: Multi-Source Extraction
SSIS packages and flat file exports extract claims from Mainframe, Oracle, and SQL Server claim administration systems into a staging environment, ensuring all claims data enters the SCHIP processing pipeline regardless of source system type.
Stage 2: Transformation & Loading
Extracted data undergoes cleansing, standardisation, format conversion, and business rule validation through stored procedures, functions, and triggers in SQL Server — harmonising data from different source systems into the SCHIP database.
Stage 3: Web UI Configuration
A Web UI enables Crawford’s operations team to define and maintain reporting entity information and matching rules without requiring code changes — providing a flexible, maintainable configuration layer that accommodates changing reporting requirements.
Stage 4: Rule Validation & SSIS Matching
SSIS packages apply configured rules to validate and match claims to the appropriate reporting entities. Testing and monitoring of SSIS packages was an active responsibility — ensuring matching logic, exception handling, and processing integrity were maintained.
Stage 5: XML Conversion & EDI Delivery
Matched claims data is mapped and converted to the Vendor XML format required by Crawford’s EDI Services. Completed XML files are delivered to EDI Services for onward transmission to vendor systems — supporting Crawford’s regulatory reporting and vendor settlement obligations.
Onsite Lead: Key Responsibilities
Requirements & Scope Management
Defined scope and deliverables with Crawford Business Analysts and Project Manager. Engaged Claim Administration System owners, SMEs, and BAs to gather requirements, data mappings, and clarifications before development commenced.
Technical Design & Development
Analysed requirements, translated into technical designs, and engaged Technical Architects, DBA, and Production Control teams. Provided hands-on guidance on stored procedures, functions, triggers, and SSIS packages.
Quality Assurance & Testing
Created test plans, test scenarios, and test evaluation summary reports. Used HP Quality Center for executing test cases and logging defects. Actively tested and monitored SSIS packages across all pipeline stages.
Offshore Coordination & Reporting
Periodic teleconferences with offshore/onsite project managers for schedule reviews. Daily status meetings and weekly status reports to Cognizant management. Design, code, and deployment reviews for all offshore deliverables.
Business Impact
Unified multi-source integration
A single governed pipeline replacing fragmented, system-specific processes for extracting and consolidating claims from Mainframe, Oracle, and SQL Server source systems.
Rules-driven reporting flexibility
The Web UI-based configuration layer lets Crawford’s operations team update reporting entity rules without code changes — significantly improving agility as business requirements evolve.
Accurate vendor data delivery
Structured XML conversion and EDI delivery ensures claims data conforms precisely to agreed formats — reducing vendor rejections, settlement delays, and regulatory reporting errors.
Delivery quality & operational confidence
Systematic testing via HP Quality Center, structured test documentation, and active SSIS monitoring provided Crawford with confidence in platform reliability before and after production deployment.
Ready to Modernise Your Claims Data Integration Platform?
Are you managing claims data across multiple heterogeneous source systems and looking to build a governed, rules-driven integration and delivery pipeline? Get in touch to explore how structured onsite delivery leadership and a proven multi-source integration approach can accelerate your claims data programme.
Pramod Siddabattuni - Product Consultant / Data Solutions Architect 