Insurance Claims Analytics – Predict future events and Manage Claims Loss

In the insurance industry landscape, majority of Fraud, Waste and Abuse claims have become a persistent problem for many insurance companies. Among this Healthcare and P & C claims constitute most number of false claims and happens on regular basis. The U.S. Department of Justice (DOJ) recently reported recovery of about $2.5 billion in claims settlement settlements […]

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Claims Auditing: Channelizing the strength of your Adjudicating Process

The economic slowdown has haphazardly hampered many commercial institutions, with the insurance industry being one of them.  The financial condition has compounded the pressure on commercial and public entities to find ways to reduce the overall operational costs.  While there are a few signs that the economy might enhance, organizations perceive that cost control will stay, and is greatly […]

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Insurance Eligibility Verification Services – Minimize Delays, Improve Collections

With wide assortment of insurance plans available for buyers, it has definitely increased the pressure on payer organization to double up their efforts in smoothly rolling the claims management process. Outsourced insurance eligibility verification services can very well define the fate of claims with close scrutiny and enhance the workflow in an insurance organization. Insurance […]

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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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Achieve Desired Business Outcomes by using Predictive Analysis

To contend successfully in a period where commercial benefits are scarce, healthcare organizations need to move beyond customary, rear-view understandings of business execution and client conduct and turn out to be more proactive. If your company is struggling for the same, then predictive analysis is the way forward. To have a financial bottom line that positively speaks about an organization’s work […]

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Improve your Business Operations by Outsourcing Contract Management Services

Outsourcing is the preferred choice in today’s heavily poised and competitive healthcare insurance industry, or for that matter any industry that requires a supply chain audit. Contract management services are the administrative operations that looking into the company’s contract life-cycle right from request to authorization. Outsourcing CMS provides healthcare payers an enterprise wide contract management features like: A comprehensive […]

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Outsourcing Claims Processing Services

The ever evolving healthcare insurance industry is facing an uphill task as far as conducting and improving their business efficiency is concerned. Despite rivalry, market instabilities, lingering stringency in rules and regulations, outsourcing your company’s claims processing service via a third-party approach can help in reducing the processing time as well the cost. Churning out ideal business […]

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