Sinelli and Associates, Inc. -- Solutions -- Health and Life

Case Studies

Large BlueCross BlueShield Plan
Sinelli and Associates, Inc. worked closely with the professionals at one of the largest health insurers in the country to implement a full range of processes for the Medicare Drug insurance program. The unusual nature of both the premium and benefit components of the product, very specific regulatory rules, and the brief period available to implement the coverages after CMS finalized the requirements made the project particularly challenging.

The consultants were very involved in designing the solution and in ensuring adequate control over all aspects of Med D processing. They created a complete flowchart of all the "cradle to grave" transaction processing and documented all of the requirements for internal control.

Large BlueCross BlueShield Plan
When a large BlueCross BlueShield Plan engineered a major corporate "turn around", the CEO (with the assistance of reorganization specialists), designed a Strategic Business Unit entity in an enterprise that previously was strongly centralized along functional lines. Sinelli and Associates, Inc. did none of the organizational design, however, we managed the project to change all of the financial systems to support the new structure. We reinstalled the General Ledger System, Accounts Payable System, and Payroll Systems to account for the new entity. A massive effort was required to rework three gigantic claims processing systems. Prior to the engagement, the claims systems produced no transactional output for the financial systems. After implementation, all of the data elements required for SBU reporting and external reporting were captured and automatically interfaced into the new ledger system.

Large Insurance Company
Sinelli and Associates, Inc. performed two major projects for the insurance division of a large brokerage house. The division consolidated five independent insurance operations into one cohesive unit. The five entities were wholly owned insurance groups located in various locations around the country. After the reorganization, all of the back office processing was established at a new site in Jacksonville Florida. Senior management and the finance staff were moved to Princeton, New Jersey.

Sinelli and Associates, Inc. designed all of the financial systems for the new entity. Business analysis included documenting profit drivers for the five companies before the consolidations and revising the drivers to reflect the new Strategic Business Unit design of the new entity. The new system supported accounting for approximately 50 statutory entities, provided monthly reporting to the parent company less than five days after month end, provided performance analysis by major line of business for the entire enterprise, and maintained a complete responsibility budget (with actual income in the budget system summarizing exactly GAAP income for each reporting period). The installation had to be accomplished very quickly. Senior management announced the change in June to be effective January of the next year. All of the definition, system interfaces, and testing was completed by December 31.

The second project was to fulfill all of the internal and external reporting requirements for a newly developed variable life annuity product. After the reorganization, the client centered their marketing efforts on one specific product. They designed a variable life product using a number of the client's mutual funds as the investment tool. We reviewed the actuarial specifications for the product and fully defined all of the data required to satisfy external statutory and GAAP reporting. We also quantified all of the data required to measure actual profitability performance compared to the initial actuarial sensitivities. We then quantified all of the data, processing, and reporting requirements from both the Vantage System, which provided policy administration, and the Sungard ABC General Ledger system. In essence, we changed the basic installation of Vantage to support subsequent reporting. After the definition, we managed the project to create all of the subsequent reports. Using the well crafted management reports, a product design flaw was identified as actual sales occurred. The product was discontinued and a slightly revised product was quickly introduced.