Claims Investigation: A Tactical Approach That Helps You Find Fraud Claims

Insurance agencies each year spend millions of dollars in investigating claims that are fraud or fake. While reasonable amount deceitful claims sneak past the claims investigator, payer organizations efficiently get hold onto some of them. And do remember that some of the most serious false claims scenario can land up the claimant in jail as well, tried under a […]

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Predictive Analytics Solutions in Healthcare Insurance – A Boon For Insurance Buyers as well as Payers

Predictive analysis in the healthcare insurance sector has achieved a paradigm shift from the customary traditions of risk assessment with analytical approach. It has the ability to change the way healthcare providers support health and well-being, while also keeping in mind the risk involved with each claim. In a recent Food and Health survey, studying customer state […]

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Claims Analytics – Analytical Techniques used in Identifying Claim Frauds

To balance the healthcare losses and to raise the overall value of a healthcare organization, claims analytics is the solution. Beyond the difficulties of meeting healthcare reforms, payers are handling complications, like changing consumer behavior and payment expectations, while also looking for customer attrition, waste and fraudulent claims and cost of operations. For most industry […]

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Adapting Risk Management For Small And Midsize Businesses

Rapid changes in the healthcare industry have affected providers and payers alike. These complexities like increasing regulatory changes affect strategic decision making. Healthcare providers need to take into account risk and compliance in order to maintain that market advantage. Two main Risks that healthcare Providers face: Fraudulent Claims Risks The US loses between $70 billion […]

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Reduce the Claim Costs via Efficient Claims Processing Service

Major business changes are underway in the health insurance sector due to healthcare reforms that are resulting in a targeted re-examination of payment processes.  Speed and accuracy to reduce claims cost to improve profitability are the underlying factors that are sought after. Even if as much as 40 percent in cost reductions are met with, […]

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