Health Insurance
Software Solutions
Optimizing payouts
Two key challenges faced by insurers are a shaky regulatory environment and a squeezed profit margin as consumers expect more benefits and lower premiums. These challenges demand a more sophisticated approach to extracting the most value from your operational data.
Regain certainty by diving deeper into your data streams with PolyAnalyst™. Harness the power of machine learning to root out fraudulent claims, and to better understand your customer interactions. PolyAnalyst transcends traditional structured data analysis systems on the market by also providing a myriad of tools for making sense of textual information, such as claims notes, provider notes in EMRs, customer surveys, competitor press releases, and social media posts.
Detect fraud and abuse
Every step of claim processing leaves a trace of data. Using this data, the analyst can determine normal behavior patterns and identify anomalies significantly deviating from the norm. The fraud detection solution based on advanced analytics can trace systematic anomalies to individual agents, service providers and insured individuals.
Audit the accuracy of medical coding
The practice of paying claims based solely on the provided structured medical codes leaves room for possible errors and abuse. Evaluation of the associated medical records could enhance the accuracy of each claim. However, manual evaluation of medical records is prohibitively slow and expensive. See how the automated solution for medical coding can read medical records and generate collections of appropriate medical codes with links to the supporting documentation.
Boost utilization management
Delivering the most effective patient care while keeping related expenses under control is a challenging goal. To justify the use of more expensive treatments, a healthcare professional might need to evaluate hundreds of clinical parameters, many of them buried deep in the medical record text. See how combining the power of information extraction and decision support systems can be of great help here.
Help your customers stay healthy
You established a call center for providing periodic check-up calls and advice to help chronically ill patients stay healthy and out of the hospital. You have thousands of nurses supporting a million patients. See how a text analysis solution can help you gain insights about key patterns, trends and emerging issues.
Understand and address customer needs
Collect unbiased feedback from your customers through all available channels, such as surveys, complaint lines, support centers, and social media. Run efficient text analysis on all data and act on the obtained insights.
Hear the voice of employees
Your employees are witnessing the problems of your customers. They are living through all pains encountered by the organization. Collect their input and learn from it to enhance your brand integrity.
Generate Associate Performance scorecards
Monitor all communications of your Support Center associates with customers to assess the performance of each associate against multiple metrics of excellence. Automatically log in the associated case management system the alerts generated on any dips in service.
Featured Customers
Manage your brand’s presence with social media analysis
Automatically aggregate and keep an up-to-date collection of customer comments and articles about your organization from various social media destinations, and then dive into the text by exploring keywords, associations between keywords and products, complaints, positive and negative product reviews, and more.