RM Cobol to Cloud-Native: Modernizing Claims Processing

Overview

Complete transformation of a 20+ year-old RM Cobol claims processing system into a scalable, HIPAA-compliant cloud-native platform. The modernized solution leverages event-driven architecture, serverless computing, and real-time data streaming to deliver dramatic improvements in processing speed, reliability, and operational costs.

The Challenge

The client operated a legacy RM Cobol-based claims processing system that had accumulated significant technical debt over two decades. The system faced critical limitations:

  • Batch-only processing causing 24-48 hour delays in claim adjudication
  • Flat file data storage severely limiting query and reporting capabilities
  • Rising maintenance costs with a shrinking pool of Cobol developers
  • No API layer, preventing integration with modern payer systems and clearinghouses
  • Architecture gaps creating HIPAA compliance risks
  • Zero horizontal scalability during peak processing periods

Solution Architecture

Designed and implemented a modern, event-driven architecture replacing the monolithic Cobol system:

  • Data Layer Migration Migrated from flat file storage to Amazon RDS MySQL with optimized schemas, proper indexing, and referential integrity. Implemented data validation rules previously embedded in Cobol business logic.
  • Event Streaming Platform Deployed Apache Kafka as the central nervous system for real-time data synchronization. Implemented Change Data Capture (CDC) patterns enabling instant claim status updates across all downstream systems.
  • Serverless Processing Engine Built AWS Lambda functions for claim validation, adjudication rules, and batch processing. Integrated with API Gateway to expose RESTful endpoints for external system integration.
  • Modern Web Interface Developed a responsive MERN stack application (MongoDB, Express.js, React.js, Node.js) providing intuitive claim management, real-time dashboards, and comprehensive reporting capabilities.
  • Integration Layer Created secure API endpoints for third-party integrations including clearinghouses, payer systems, and healthcare information exchanges.

Technology Stack

  • Data & Streaming: Apache Kafka, Amazon RDS MySQL, Relativity, CDC Connectors
  • Frontend: React.js, Node.js, Express.js, MongoDB, Tailwind CSS
  • Cloud Infrastructure: AWS Lambda, API Gateway, S3, CloudWatch, EventBridge, Step Functions
  • Security & Compliance: AWS KMS, IAM, VPC, CloudTrail, HIPAA-compliant configurations
  • DevOps: CI/CD Pipeline, Infrastructure as Code, Automated Testing, Blue-Green Deployments

Key Deliverables

  • Real-Time Data Streaming Kafka-powered event streaming enabling instant claim status updates and cross-system synchronization, eliminating batch processing delays.
  • HIPAA-Compliant Architecture End-to-end encryption at rest and in transit, comprehensive audit logging, role-based access control, and secure PHI handling meeting all healthcare regulatory requirements.
  • Serverless Processing Auto-scaling Lambda functions for cost-efficient processing, handling variable workloads without infrastructure management overhead.
  • Data Migration Framework Custom ETL pipelines for migrating historical data from flat files to relational database with data quality validation and reconciliation.
  • Third-Party Integration APIs RESTful API layer connecting clearinghouses, payers, and healthcare information exchanges with standardized data formats and secure authentication.
  • CI/CD Pipeline Automated build, test, and deployment pipeline with staging environments, automated rollback capabilities, and infrastructure as code.

Results & Impact

Metric

Improvement

Claim Processing Time

85% faster (from 24-48 hrs to under 4 hrs)

System Availability

99.9% uptime achieved

Infrastructure Costs

60% reduction in operational expenses

Concurrent Capacity

10x increase in simultaneous users

Integration Capability

From 0 to 12+ connected systems

Compliance Status

Full HIPAA compliance achieved

My Contributions

  • Led end-to-end solution architecture design and technology selection
  • Designed data migration strategy from legacy flat files to relational database
  • Architected and implemented Kafka event streaming pipeline
  • Built serverless processing layer using AWS Lambda and API Gateway
  • Established HIPAA compliance framework across all system components
  • Developed RESTful APIs for third-party payer and clearinghouse integrations
  • Implemented CI/CD pipeline with automated testing and deployment
  • Provided technical leadership and mentorship to development team

Skills

  • Solution Architecture
  • Legacy Modernization 
  • Cloud Migration 
  • Healthcare IT
  • HIPAA Compliance 
  • Event-Driven Architecture
  • Apache Kafka 
  • AWS (Lambda, RDS, API Gateway)
  • MERN Stack
  • Serverless Computing 
  • Data Migration
  • API Development 
  • CI/CD
  • Technical Leadership

Available for similar legacy modernization, healthcare technology, and cloud migration projects.

Architecture Diagram