Strategy Datamatics Implemented to Enhance Operations with PBoR for a UK Insurer

A global leader in healthcare and insurance, this UK-headquartered company serves over 38 million customers across the world. Beyond insurance, they operate an extensive network of clinics, dental centers, and hospitals across multiple international markets, ensuring access to high-quality healthcare services.

The Challenge: Operational & Financial Bottlenecks

The client faced mounting disruptions driven by an evolving digital landscape. With increasing regulatory demands, rising customer expectations, and complex provider networks, the company was under constant pressure to enhance service delivery at every touchpoint.

One of the biggest challenges in the health insurance industry is the absence of a unified solution that integrates provider management, contract administration, claims verification, and payment processing. 

For the Chief Information Officer (CIO), these inefficiencies posed a significant operational and technological challenge. Outdated, fragmented systems lacked interoperability, making data accuracy and real-time processing difficult. Without a streamlined, end-to-end digital framework, the company risked higher operational costs, payment inaccuracies, and prolonged claim settlement cycles—challenges that could significantly impact its financial performance, provider trust, and market competitiveness.

The Solution: Seamless Provider Management

To address these operational and financial inefficiencies, the client partnered with Datamatics to implement the Provider Book of Record (PBoR)—a robust, cloud-based framework designed to streamline provider management. PBoR automates critical processes such as provider onboarding, credentialing, and contract management, eliminating manual bottlenecks and enhancing operational accuracy.

Built on the Microsoft Dynamics 365 Service module, PBoR is customized to provide advanced contract management and claims validation capabilities. It seamlessly integrates with multiple core systems, including Policy Administration, Pre-Authorization & Claims Management, Rules Engine, Provider Portal, and Finance Systems, ensuring real-time data connectivity and interoperability. This unified approach not only optimizes provider workflows but also enhances claim accuracy, reduces overpayments, and accelerates reimbursement cycles—ultimately improving provider satisfaction and financial efficiency.