Health Insurers are plagued by high loss ratios arising from fraud, overtreatment and high levels of claims resulting in loss making operations. We help organisations:
- Review, optimize and implement supporting technologies that integrate provider systems and their core systems for electronic data interchange
- Develop and implement claims management analytics that provide value chain transparency and fraud management. This includes models for automated claims adjudication
- Set up claims adjudication quality assurance structures and training not only in the adjudication process, but also in the management of providers