Claims Adjustments Application

The Vendor is required to provide claims adjustments application for include:
1. Claims adjustments application delivery
•    Design, develop, and enhance secure digital workflows that enable the submission, review, adjudication, and processing of claims.
•    Support claim adjustments related to child attendance, educator and staff information, funding eligibility, and payment discrepancies, in accordance with applicable business rules and policies.
•    Implement role-based access controls, audit logging, and end-to-end traceability across claims, adjustments, and related payment activities, without reliance on customizations outside the approved application configuration.
•    Enable incremental feature releases that support continuous improvement while maintaining service availability and avoiding disruption to production operations.
2. System integration
•    Design, develop, and implement secure integrations, as required, with the following systems and services:
o    Child registration service
o    Licensing service
o    Funding service
o    Claim submission service
o    Child care information system (CCIS)
•    Integrate the application with the province’s identity and access management (IAM) solution, CI/CD pipelines, and cloud hosting environments.
•    Provide and maintain integration documentation, monitoring, and error-handling mechanisms sufficient to support operational support, troubleshooting, and auditability.
3. Reporting and analytics
•    Design, develop, and maintain product-level reporting and analytics capabilities for the claims adjustments application.
•    Provide operational reporting on claims and adjustment volumes, processing times, and trend analysis.
•    Provide financial and reconciliation reporting to support payment processing, funding programs, and audit requirements.
•    Deliver data models and datasets aligned with the province’s analytics platforms, including azure data bricks.
4. Technical and architecture deliverables
•    Implement a component-based, scalable architecture aligned with the province’s preferred technology standards.
•    Deploy the solution in province-approved cloud environments.
•    Implement automated testing, CI/CD enablement, and performance monitoring to support quality, reliability, and maintainability.
•    Deliver and maintain technical documentation covering system architecture, integrations, and operational support requirements.
5. Product delivery
•    Align product vision, outcomes, and success measures with the child care digital service roadmap.
•    Establish, prioritize, and maintain a product backlog that includes functional, technical, and reporting requirements.
•    Develop and maintain an incremental delivery roadmap and release plan aligned with policy and funding milestones.
•    Collaborate on an ongoing basis with province product owners and related delivery teams to support effective delivery and decision-making.
6. Service design and user experience
•    Produce user-centered service design artifacts supporting end-to-end claims and adjustment workflows.
•    Deliver design assets that ensure a consistent and unified operator experience across initial claims and subsequent adjustments.
•    Ensure interfaces are accessibility-compliant and usability-tested for both external operators and agency staff.
7. Operational support and continuous improvement
•    Provide production support, including defect resolution and ongoing performance monitoring.
•    Maintain and refine the product backlog to address policy changes, funding updates, and evolving program requirements.
•    Complete knowledge transfer and documentation sufficient to support operational readiness, continuity, and long-term sustainability.