Claims Analysis Model
A healthcare analytics company
Our client is a healthcare analytics company that derives meaningful insights and delivers effective solutions to help clients optimize performance.
They wanted to leverage big data technology to improve the effectiveness of healthcare in the following areas:
- Reducing medical costs
- Reducing administrative costs
- Improving operating effectiveness and compliance
Claims analysis model redesign
Datametica redesigned their claims analysis model. Datametica built a new analysis model to analyze the claims records by using a strong rule-based engine which looks up thousands of complex rules and recommends scenarios where the claims were on a higher side. The model proposed a revised claim amount which helps the insurance companies in saving millions of dollars.
Data sanitization/data reconciliation tracks
Datametica was also involved in building a data sanitization/data reconciliation track, which involved ingesting the claims transaction, data validation, exception handling and de-duplicating records. The cleansed records are fed to the claims analysis model.
Reduced processing time
The redesigned claims analysis model reduced the processing time by more than 50%
New model churns the output in an efficient and accurate manner
Savings for insurance companies
Savings in millions of dollars for insurance companies