Transparent Online Claim Management Suite (ToCMS)
Project Overview
ToCMS (Transparent Online Claim Management Suite) is a mission-critical group insurance operations platform engineered for Life Insurance Limited (LIL). Transformed from a legacy Laravel framework into a modern Next.js App Router solution, it orchestrates end-to-end employee group policy contracts, medical claim submissions, multi-stage approval hierarchies, panel hospital networks, and financial bank disbursements.
Architecture & Role: Lead Solution Architect & Full-Stack Engineer designing the decoupled Next.js architecture, Prisma ORM data modeling on MySQL/Oracle, transactional state machines, B2B corporate REST APIs, and granular role-based access control (RBAC).
Key Accomplishments & Architecture Highlights
- Business Problem: Replaced fragmented claims coordination and spreadsheet handoffs between corporate HR departments, hospital networks, and insurers with an end-to-end auditable digital claims pipeline.
- Multi-Stage Workflow Pipeline: 8-tier review state machine (Member → HR Verification → Initiator → Medical Officer → Internal Audit → Dept Head → CFO → CEO Signoff) with dynamic monetary approval ceilings per reviewer role.
- B2B Corporate Client REST API Suite: Secure external API gateway (/api/v1/b2b/claims) backed by rotating API keys (X-Corporate-API-Key), empowering corporate client ERP and HR portals to submit employee claims and track live status in real-time.
- Loginless OTP Submission & Status Tracking: Public unauthenticated self-service portals (/submit-claim & /track-claim) secured by anti-phishing 3-letter prefix code anchors and 6-digit OTP verification via SMS/Email.
- Cashless IPD & 90-Day Relapse Engine: Automated OPD, IPD, maternity, dental, optical sub-limit calculations, co-pay deductions, and per-disability relapse window tracking against corporate policy plan grades.
- BEFTN Financial Batch Advising: Automated generation of sequential payment advice lots (LOT-YYMM-xxxx) and multi-sheet BEFTN Excel (.xlsx) clearing files for seamless Bangladesh Electronic Funds Transfer Network bank disbursements.
- Business Impact: Accelerated group claim settlement cycles from 3+ weeks down to under 48 hours, prevented limit overruns through real-time balance checks, and provided corporate HR with 100% transparency.
Tech Stack & Tools
Project Category
Full Stack • Web Dev • Backend
Project Type
Professional Enterprise Project
System Screens & Interface Showcase
Click on any screenshot to open the interactive fullscreen preview modal.
Executive Operations & Claims Analytics Dashboard
Real-time operational command center displaying active group claims, settlement ratios, financial processing queues, and live KPI summary metrics.
Unified Multi-Category Claim Submission Form
Multi-step claim filing interface supporting OPD, IPD, Dental, Optical, Maternity, and Death claims with dynamic limit computation and document uploads.
Comprehensive Claim Audit Voucher & Sub-Limit Verification
Full-screen audit modal displaying employee history, previous claims, remaining category balances, co-pay deductions, and printable voucher formats.
Multi-Stage Review & Claim Handling Action Flow
Interactive desk processing action workflow showing stage progression, reviewer remarks, forwarding chains, and approval ceiling enforcement.
Public Loginless Claim Submission Gateway
Public self-service claim intake page secured with anti-phishing prefix anchors and SMS/Email OTP identity verification.
Role-Scoped Operational Claims Analytics & Visual Charts
Role-partitioned reporting suite featuring interactive ApexCharts for category distribution, processing queues, and financial disbursement comparisons.
Dynamic Site Settings, Timezone & Branding Engine
Administrative configuration engine managing database-driven software identity, Asia/Dhaka UTC+6 standardization, SMTP/SMS gateway switches, and one-click database backups.
Group Policy Plans, Grade Caps & Benefit Riders Setup
Tiered corporate grade limit configuration panel defining per-person sub-limits for hospitalization, surgery, outpatient, and Group Term Life (GTL) riders.
Granular Role-Based Access Control (RBAC) & Permission Matrix
Enterprise user access control hub configuring permission matrices for Super Admin, Initiator, Corporate HR Organizer, Medical Officer, and Internal Audit roles.
