Claims Analytics

Beyond the challenges of meeting healthcare reform mandates, payers are tackling challenges such as changing consumer payment expectations as well as increasing customer attrition, claims fraud and cost of operations. For most industry players, claims and related adjustment expenses contribute to over 80% of the cost – the single largest expense directly impacting their profitability. This makes it critical for them to control claims related costs.
In order to address these challenges effectively, payer organizations need to invest in robust solutions to draw actionable insights from underlying data residing in disparate sources to improve organizational efficiency. Payers currently experience a few roadblocks in achieving this:

Claims analytics challenges

What We Offer

Our comprehensive analytics solution enables insurers to make fact based decisions based on high quality data. Its key components comprise a scalable staging framework, dimensional models, BI platforms, and mobility. The analytics platform generates reports, KPIs and dashboards to measure business performance. The three-phased, ‘plug-in’ solution is easy to deploy and comes with in-built ETL, DW, and BI capabilities which support multiple deployments and support options including cloud. Additionally, it provides connectivity and access to analytics on multiple devices such as web, mobile, and tablets as well as the ability to effectively:

  • Build operational reports
  • Monitor fraud and analytics
  • Conduct predictive / what-if analysis
  • Provide the organizational leadership team a comprehensive executive dashboard

How We Deliver Value

The solution simplifies analytics by eliminating a complex environment of multiple service teams, vendors, Business and IT departments. It accelerates the build out of the platform and speeds up data insights with pre-defined logic. Claims efficiency is further enhanced by deploying modeling and analysis to track fraudulent claims, and provide meaningful business insights for superior decision making. Key components of the solution include:

  • Scalable Staging Framework: CDC enabled ETL on replica / sourced data, requiring minimal modifications
  • BI Platform and Outputs: Analytic abstraction universes, summary tables, in-memory Hadoop summarizations
  • Dimensional Models: Fact based subject areas, with conformed dimensions and extensible design
  • Mobility: Responsive design, device independent access, extendible to the ‘app stores’

Benefits We Offer

Some of the business benefits offered by our solution include:

  • ACCELERATED build-out of analytics platform by 6 – 9 months
  • SIGNIFICANT cost savings from resources, upkeep, HW, SW, ETL, and BI components
  • Only Facets-based Analytics solution, in the market, providing operational reports, predictive analytics, and executive dashboards