Claims Analysis Model

healthcare

Client

A healthcare analytics company

Our client is a healthcare analytics company that derives meaningful insights and delivers effective solutions to help clients optimize performance.

Challenges

Project scope

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

Solution

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.

Solution

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.

Benefits

time-1
Reduced processing time

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

widesupport
Efficient

New model churns the output in an efficient and accurate manner

costsavings
Savings for insurance companies

Savings in millions of dollars for insurance companies

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