Strategy and Solutions

Zymr developed a robust QA framework tailored to the ACA compliance requirements of the portal. We built a comprehensive test suite to verify coverage rules and subsidy calculations, ensuring accurate premium and benefit determination. Automated EDI data validation was implemented to check the integrity of 834 transactions across carriers and marketplaces. Cross-browser and accessibility testing was conducted to meet WCAG and Section 508 standards, ensuring usability for all users. Integration testing with payment gateways and CRM systems was performed to deliver a seamless end-to-end enrollment experience.

About the Client

A leading U.S.-based health insurance provider offering ACA-compliant plans for individuals and small businesses. The client was launching a new online enrollment portal to meet Affordable Care Act (ACA) mandates, with integrated eligibility checks, subsidy calculations, and EDI-based data exchanges.

Key Outcomes

Reduced manual verification workload by 60%.

Increased user satisfaction scores by 25% post-launch.

Business Challenges

The enrollment process required strict compliance with ACA rules and federal/state marketplace requirements. Manual validation of coverage eligibility and subsidies was error-prone and slow. The complexity of EDI 834 transactions across multiple partners introduced risk of non-compliance. The client faced tight timelines to launch before the open enrollment period.

Business Impacts / Key Results Achieved

The portal passed external compliance audits with zero critical issues and went live on schedule for open enrollment. Subsidy calculation accuracy reached 100%, and enrollment error rates dropped by 85%.