Build the WHPS AI and platform modernization program.
WHPS is rebuilding the operating platform across portals, service AI, mainframe modernization, data, integration, and AI SDLC controls. The plan connects architecture, migration waves, release evidence, and operating outcomes.
Product platforms replace fragmented service and enrollment workflows.
Mainframe exit is managed by bounded domain, not big-bang rewrite.
Every capability ships with proof, owner, rollback path, and runbook.
WHPS delivery control plane
A shared execution layer that connects program scope, engineering delivery, architecture decisions, and production release controls.
Build an AI-enabled payer platform around the real operating domains of HPS.
Wipro HPS already operates in the payer domains that matter: sales, enrollment, billing administration, member service, retention, broker operations, group administration, and regulated ACA workflows. The strategy is to turn those operating strengths into product platforms, controlled AI workflows, domain services, and migration waves that reduce legacy dependency while improving service quality.
Member service becomes a digital operating product.
Coverage, billing, documents, secure messages, service requests, and CRM context move into one governed member-service surface with evidence and support ownership.
Broker operations need certification-grade control.
ACA EDE workflows require CMS-facing evidence, role access, consent, RIDP/NPN context, enrollment status, document flow, and audit-ready transaction logging.
Service intelligence starts with supervised agent assist.
AI drafts, retrieves, summarizes, and stages service actions while agents approve customer-facing responses and QA captures every source and edit.
Modernization is certified by parity and retirement.
Domain waves use facades, contract tests, data reconciliation, dual run, rollback, and decommission ledgers before savings are counted.
The next platform shift is direct agent-to-system orchestration.
Screen automation is a bridge. The target architecture is a governed account control plane where agents can read, reason, act, and prove outcomes through scoped healthcare service contracts instead of imitating a human across dozens of portal screens.
Agents inherit human UI constraints.
Credentials, browser sessions, brittle selectors, screen recordings, and portal workflow latency limit what agents can safely do at scale.
Services expose governed action contracts.
Eligibility, enrollment, billing, documents, communications, and CRM actions become policy-controlled services with deterministic read/write paths.
Identity, consent, policy, evidence, and rollback are centralized.
The platform proves what changed, why it changed, which authority approved it, and how to reverse or reconcile it.
DGX pods enable specialized healthcare task models.
WHPS can train or fine-tune lightweight models for repeatable payer tasks, hosted on premises or in controlled cloud containers with predictable operating economics.
Move from legacy dependency to product platform control.
The program uses a progressive modernization model: make the estate observable, stabilize integrations, encapsulate volatile legacy contracts, rebuild product capabilities, migrate data with parity proof, and retire old cost only after consumers are gone.
Inventory the operating estate.
Catalog portals, service flows, COBOL/JCL/CICS/Db2/VSAM assets, feeds, documents, CRM dependencies, and owners.
- Dependency graph
- Runtime volume baseline
- Risk and ownership map
Stabilize access and integration paths.
Put IAM, API gateway, audit logging, service-test replay, and data contracts around critical interactions.
- Facade and contract tests
- Evidence capture
- Fail-closed controls
Deliver target capabilities by domain.
Modernize member, broker, group, service, AI, and data capabilities as product platforms with release gates.
- Product backlog
- Target architecture
- UAT and adoption telemetry
Cut over only with parity and retirement proof.
Use dual run, reconciliation, canary routing, rollback, and decommission ledgers before counting savings.
- Parallel run proof
- Consumer-zero evidence
- Finance-verified retirement
Migration strategy How mainframe dependency moves out of the critical path.
WHPS keeps stable mainframe behavior available during transition while new product services take over bounded capabilities. Traffic moves through versioned APIs and events, with weighted routing, contract tests, reconciliation, and rollback maintained until production parity is proven.
Modern platform What replaces the fragmented operating model.
The target platform combines ServiceLink Portal, broker/agent pathways, GroupLink Portal, Contact Center AI, shared IAM, API/event services, RAG, CRM integration, data services, observability, and AI SDLC evidence as one governed delivery system.
Release evidence What proves a capability is safe to operate.
Each release carries architecture decisions, business requirements, source-system contracts, test replay, eval results, security review, support runbook, rollback plan, production telemetry, and named ownership.
The actual builds and migrations in scope.
Each workstream has a product owner, architecture view, source-system dependency map, delivery backlog, release gate, adoption measure, operating support path, and detailed business requirements catalog.
- Member service, billing, coverage, documents, secure inbox, and guided support workflows.
- Identity, payment state, document retrieval, CRM handoff, and ServiceLink billing context.
- Exit gate: billing parity, secure inbox evidence, support runbook, and member-service UAT.
- Broker-facing enrollment operations, document exchange, status orchestration, self-service controls, and MarketLink greenfield build evidence.
- Identity, role access, API contracts, document services, CMS/EDE evidence, and CRM/service routing.
- Exit gate: UAT, API tests, defect burn-down, third-party assessment, pen test, vulnerability scan, CMS handoff, and production readiness evidence.
- Group administration, eligibility, account workflows, permissions, reporting, and modernized CSR operations.
- Source sync, role model, data quality checks, audit trail, Christos onboarding, and operational handoff.
- Exit gate: integration checks, access review, workflow acceptance, UAT, and support runbook.
- Voice/chat intake, transcript, intent, RAG, claim/service lookup, suggested response.
- Agent approval, CRM writeback staging, QA archive, knowledge backlog, fail-closed path.
- Exit gate: call replay, source citations, agent edits, QA scoring, incident controls.
- AI inventory, model/prompt/tool registry, scoped agents, eval harness, CI evidence.
- Release gates for privacy, security, grounding, prompt injection, runtime monitoring.
- Exit gate: AI BOM, scan output, eval pass, approvals, rollback plan, production telemetry.
- COBOL/JCL/CICS/Db2/VSAM inventory, dependency graph, domain disposition, wave plan.
- Facade, data replication, reconciliation, dual run, cutover, rollback, decommission ledger.
- Exit gate: parity proof, consumer signoff, retired jobs/interfaces/licenses/contracts.
- IAM, API gateway, observability, evidence store, data contracts, environment strategy.
- Shared patterns for portals, AI services, service APIs, CRM, RAG, and mainframe interfaces.
- Exit gate: reference architecture, runbooks, SLOs, access controls, release automation.
Four platform briefs for leadership, architecture, delivery, and support questions.
Each platform has a concise answer for users, capabilities, source systems, release evidence, measures, and risks. These are target-state briefs until the final WHPS inventory confirms system owners and integrations.
| Platform | Primary users | Core capabilities | Source-system dependencies | Release evidence | Measures and risks |
|---|---|---|---|---|---|
| ServiceLink Portal | Members, service teams, billing support, operations. | Coverage, billing, premium status, documents, secure inbox, guided support, CRM handoff. | IAM, billing, policy admin, document service, CRM, payment/reconciliation, mainframe facade. | Billing parity, document retrieval tests, access review, secure inbox evidence, support UAT. | Member self-service adoption, call deflection, billing accuracy, PHI/privacy risk. |
| Broker/agent pathway | Brokers, agency admins, WHPS broker support, compliance reviewers. | EDE enrollment support, application status, document workflows, book of business, service cases. | CMS Hub/EDE, RIDP/Experian, NPN/RCL, eligibility, enrollment, CRM, document service. | CMS toolkit outputs, BRA evidence, API contract tests, role matrix, consent/AOR audit. | Enrollment conversion, broker adoption, CMS audit readiness, EDE certification dependency. |
| GroupLink Portal | Group administrators, account managers, eligibility operations, reporting teams. | Group administration, eligibility files, roster management, account workflows, reporting. | IAM, group account systems, eligibility, billing, document service, reporting lakehouse. | File validation, role access review, workflow acceptance, data quality checks, support runbook. | Eligibility accuracy, admin adoption, data quality, reconciliation and permission risk. |
| Contact Center AI | Agents, supervisors, QA, knowledge managers, service operations. | Transcript, intent, RAG, source citations, suggested responses, CRM staging, QA scoring. | Telephony, CRM, policy/claim/eligibility APIs, knowledge base, model runtime, evidence vault. | Call replay, citation trace, agent approval, QA score, fail-closed runbook, incident path. | Handle time, first-contact resolution, quality score, grounding and PHI handling risk. |
The program is organized around products, platforms, and release controls.
Every initiative has a named product, target architecture, source-system dependency, migration path, release gate, production owner, and measurable operating outcome.
Transformation objectives are converted into prioritized epics with named owners, success measures, risk tier, and release gates.
Broker workflows, group administration, customer calls, claims processes, and engineering delivery are mapped before automation is introduced.
Contact Center AI assist, engineering agents, retrieval services, and workflow automation operate with identity, scoped authority, approved tools, evals, and human decision gates.
ServiceLink Portal, broker/agent pathways, GroupLink Portal, CRM, service APIs, RAG stores, core platforms, mainframe interfaces, IAM, logs, and telemetry are designed as a governed runtime.
Policy becomes release evidence: risk review, model inventory, prompt registry, change approval, incident response, platform adoption, service quality, and operating telemetry.
Strategy-to-platform implementation map.
This is the program traceability model: every objective maps to product epics, domain workflows, source-system dependencies, control gates, production telemetry, and accountable operating outcomes.
Set the target outcome, owner, risk tier, release path, and operating cadence.
Define the portal capability, service measure, adoption signal, exception threshold, and user impact.
Map identity, eligibility, group setup, service requests, retrieval, approvals, CRM updates, and QA review.
Connect portals, APIs, RAG, policy engine, CRM, mainframe interfaces, observability, and evidence stores.
Require evals, source citations, tool-call logging, human approval, rollback plan.
Monitor quality, incidents, drift, overrides, cost, latency, and knowledge gaps.
WHPS transformation system map.
This is the program architecture in one view: channels and portals feed a governed AI and delivery control plane, integration services protect source systems, and the mainframe migration path removes dependency by wave.
Mapped to enterprise modernization and AI delivery patterns.
The content is grounded in Wipro payer and modernization positioning, CMS EDE controls, AWS mainframe modernization patterns, NIST, OWASP, DORA, and enterprise AI governance practices, then translated into WHPS-specific execution views.