Cloud-based Claims Analysis Model

moderndataplatform

Client 

Leading healthcare analytics company

The client is a leading a healthcare analytics company that provides payment integrity solutions including integrated claims management services and claims review services.

Project scope

Business drivers

They wanted to leverage big data technology to improve the effectiveness of healthcare in the following areas:

  • Reducing claims costs
  • Reducing administrative costs
  • Improving fraud detection, operating effectiveness and compliance.

Solution

Claims analysis model redesign

Datametica was involved in redesigning their claims analysis model on the cloud. we built a new analysis model to analyze the claims records by using a strong rule-based engine which would look up thousands of complex rules and recommend scenarios where the claims were on a higher side. The model would propose a revised claim amount which would help the insurance companies save millions of dollars.

Solution

Data sanitization/data reconciliation track

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 were fed to the claims analysis model.

Benefits

time-1
Reduced time

The redesigned claims analysis model reduced the processing time by more than 50%

operational
Efficient & Accurate

The new model was able to churn the output in an efficient and accurate manner

costsavings
Cost savings

It ensured savings in millions of dollars for insurance companies

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