Revolutionizing Healthcare with Cutting-edge IT Solutions

The size of the global healthcare claims management market was USD 16.8 Billion in 2024. In the future, IMARC Group believes the market will grow to USD 33.4 Billion by 2033 at a growth rate (CAGR) of 7.55% between 2025-2033. The rising complexity of healthcare management systems, increased healthcare expenses and demands for cost containment, the evolution in technology such as adoption of automation and artificial intelligence (AI), and the transition towards value-based care models are some of the key drivers fuelling the market. In the midst of this challenge, innovation in healthcare IT is transforming claims adjudication, enhancing accuracy, and bettering patient outcomes. Haritha Murari, a Master’s level senior system architect with more than 12 years of experience in the development of IT applications, with certifications as a Pega Certified Senior System Architect and Decision Consultant, has been leading these transformations. Her experience, involving simplifying claims processing for a large health plan serving federal employees, has enabled measurable efficiency and well-being in the community to increase.

The healthcare IT sector is affected by ongoing problems like high denial rates on claims, delayed processing through manual efforts, and disparate data systems. About 15% of claims are initially denied because of errors in determining eligibility, which costs providers billions each year. Current solutions, including traditional batch-processing systems, don’t have the speed and adaptability required for real-time validation, resulting in backlogs and frustrated providers. Contemporary platforms based on Business Process Management (BPM) tools, such as Pega PRPC, provide dynamic workflow and integration capabilities but need profound expertise to match sophisticated regulatory and operating requirements.

It is at the core of this change that a real-time eligibility verification processor was created, a showcase project reinventing claims adjudication. This processor interconnects with external payers’ systems via EDI X12 270/271 transactions, automatically processing eligibility verification and routing decisions. By creating modular case types, decision tables, and data structures, the architect facilitated easy data exchange and adherence to federal requirements. The project lowered claim rejections by 35% and eligibility check times by 40%, which directly enhanced revenue cycle management.

“Automation is crucial about speed; it’s about providing providers and patients with the confidence that claims are processed correctly the first time,” Haritha highlighted and emphasized in a project review.

The other primary initiative was to improve decision-making using predictive models and AI-based solutions. Through the combination of adaptive analytics and constrained generative AI, the system improved outbound messaging and self-service capabilities, increasing member response by 15%. These advancements simplified customer interactions, decreasing call center volumes and enabling patients with clearer, quicker information. The community impact is evident: faster claim resolutions mean providers can focus on care delivery, while members experience fewer billing disputes, fostering trust in the healthcare system.

Aside from Haritha’s technical contributions, the architect’s leadership also extended to mentorship and other responsibilities. She mentored junior developers in Pega best practices, promoting a culture of high-quality, reusable code. Her designs on deployment automation frameworks, employed with queue processors and job schedulers, became organizational best practices, enhancing system stability across environments. What she did was recognized within the organization, as her eligibility processor designs were showcased in case studies and used as a model for billing and provider credentialing modules.

It’s fulfilling to see my designs become a base for others to innovate from, creating an efficiency ripple effect,” Haritha mused.

Her work outside the company further increases this impact. Peer-reviewed articles appearing in IEEE conferences and worldwide journals examine healthcare IT innovation, driving industry standards. She influences acknowledgement of change-making technologies as a reviewer for international IT awards such as Brandon Hall and Globee. These activities establish her as a thought leader, enabling scalable, patient-driven adoption. Her mentorship continues to include judging competitions, encouraging young professionals to address healthcare challenges out of the box.

Measurable statistics highlight the impact of her work. The eligibility processor raised first-pass resolution rates more than 20%, minimizing provider-payer reconciliation lag times. By automating manual checks for thousands of claims per day, it saved operational expenditures. These gains not only accrue to the organization but also to the broader community of federal retirees and employees who depend on prompt access to healthcare. Across the world, these systems serve as standards to eliminate administrative inefficiency so that healthcare systems can channel resources towards patient care.

The architect’s awards are a testament to her impact. Business and IT leadership recognize her internally with awards for claims processing innovations. Her design templates, now used by all departments, illustrate functional innovation. Her innovation disrupts traditional paradigms, transforming from sluggish, error-prone batch systems to real-time, dynamic processing. The change synchronizes with industry direction toward automation and interoperability, enabling healthcare organizations to address increasing demands.

Looking forward, the design principles of her projects, modularity, scalability, and compliance provide a model for future challenges, including the integration of AI-based diagnostics or enlarging telehealth. By eliminating inefficiencies, her work saves resources for preventive care and community health initiatives, leaving a lasting legacy. Her emphasis on reusable designs and optimization for performance allows systems to evolve with changing regulations and patient needs, creating a global benefit to stakeholders.

In an industry struggling with complexity, Haritha Murari’s work is an example of the way that focused IT solutions can address structural problems. Her projects not only make operational metrics better but also better the lived experience of providers and patients, showing that technology, when applied deliberately, has the power to fix healthcare for the better.