Modernize Healthcare Claims and Member Service Systems with AI

Across North America, healthcare organizations still depend on core claims and service platforms built decades ago. COBOL, Synon and mainframe-based workflows continue to process high-volume claims, support member and customer service, and hold together critical operational processes. These systems still run the business, but they were not designed for today’s expectations around speed, flexibility, cloud-native delivery, real-time integration or AI-enabled operations.

For payer and provider leaders, that creates a difficult reality. The business cannot simply rip and replace the systems that adjudicate claims, support service teams and protect continuity. Yet every delay in modernization increases cost, slows change and limits the ability to improve experiences for members, patients and employees. Business rules are often buried deep inside legacy code. Documentation is incomplete or outdated. Dependencies stretch across screens, databases, interfaces and workflows that only a handful of people fully understand. In a compliance-sensitive environment, every change carries risk.

This is where a different modernization model matters. Instead of treating healthcare transformation as a risky rewrite, Publicis Sapient applies AI to uncover what legacy systems actually do, preserve the logic that matters and accelerate delivery of a modern target state with greater confidence and control.

Healthcare organizations often know exactly which systems are holding them back. Claims platforms become rigid. Service applications make change expensive. Mainframe maintenance absorbs budget that should be funding innovation. But modernization slows because the hard part is not deciding to move. It is understanding the full business behavior encoded in legacy environments before anything changes.

Claims systems are especially challenging because they combine high transaction volumes with strict operational expectations. They support workflows that cannot tolerate disruption. They also reflect years of institutional knowledge embedded in code, workarounds and undocumented process decisions. When that logic is hidden across thousands of screens and tightly coupled dependencies, manual analysis becomes slow, costly and error-prone. Testing becomes a bottleneck. Governance gets bolted on too late. Programs drag on for years without producing the operational shift leaders need.

That is why successful healthcare modernization starts with visibility. Before systems can be rebuilt, teams need to extract buried rules, map dependencies and turn legacy logic into something that can be reviewed, validated, tested and carried forward into a modern architecture.

Sapient Slingshot is an AI-powered software development platform built to modernize legacy systems and support delivery across the full software development lifecycle. For healthcare organizations, it helps break through legacy gridlock by reading and interpreting existing code, extracting business rules and generating verified specifications before rebuilding begins.

That foundation changes the modernization equation. Instead of relying on incomplete documentation or costly reverse engineering, teams gain a clearer view of how claims and member-service systems behave today. Slingshot maps dependencies across code, architecture and data, helping organizations preserve essential business logic while designing a more flexible future-state platform.

It then accelerates delivery through automated specification generation, AI-assisted code transformation, automated test generation and cloud-native target-state delivery. Human-in-the-loop validation remains critical throughout the process, helping teams maintain quality, traceability and business fidelity in a regulated environment. The result is not AI operating as a black box. It is AI augmenting experienced teams with more context, more speed and more control.

Slingshot is designed to deliver up to 99% code-to-spec accuracy and can accelerate delivery timelines by as much as 3x. For enterprises modernizing legacy applications more broadly, it can reduce modernization costs by up to 50% while improving test coverage and reducing manual effort.

A leading U.S. healthcare organization needed to modernize more than 10,000 COBOL and Synon mainframe screens that supported claims processing and customer service. Its legacy platform had become a fragile bottleneck. After years of effort, only a small portion of the system had been updated, leaving critical operations stuck in legacy gridlock and limiting future innovation.

Using Sapient Slingshot, Publicis Sapient helped the organization uncover hidden business rules and dependencies across the estate, transform legacy code into clean, maintainable modern technologies, and generate functional specifications and test cases to speed quality assurance. Automated testing reduced manual errors, while cloud-native deployment created a more resilient platform for future change. Human oversight at key points helped ensure quality and compliance throughout the modernization effort.

The outcome was concrete and measurable: 10,000 screens modernized, 3x faster migration speed and a 30% reduction in modernization costs. More importantly, the organization was able to modernize core claims and service capabilities without disrupting the operational backbone the business depended on every day.

For North American healthcare leaders, modernization is no longer just a technology agenda. It is an operational resilience agenda, a service agenda and a growth agenda. Claims platforms and service systems influence cost to serve, speed of change, employee productivity and the experience delivered to members, patients and providers.

Modernization done well creates more than cleaner code. It gives organizations a stronger foundation for cloud-native operations, more adaptable claims workflows, faster release cycles, better testing discipline and lower dependence on aging mainframe environments. It helps service organizations respond faster. It reduces the fragility that slows transformation. And it creates a platform that can support new digital experiences and AI-enabled workflows without carrying forward the constraints of the past.

The key is to modernize without losing what already works. In healthcare, that means preserving critical business rules, respecting compliance requirements and maintaining continuity under real production demand. That is why AI must be applied with traceability, governance and human judgment built in from the start.

Healthcare organizations do not need another long transformation program defined by manual analysis, disconnected tools and rising delivery risk. They need a practical path to modernize the systems that matter most while keeping high-volume operations running.

Publicis Sapient brings together deep industry experience, AI-powered platforms and modern engineering execution to help healthcare organizations make that shift. With Sapient Slingshot, legacy code becomes visible, business logic becomes testable and modernization becomes a governed, accelerated path to a cloud-native future.

For payer and provider executives facing the challenge of aging claims and member-service platforms, the opportunity is clear: preserve what is essential, reduce what is fragile and modernize with confidence.

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