Medical Claims Analysis services help healthcare providers with early identification of diseases, sort members based on disease maturity, estimate cost - predicted VS Actuals and take preventive action through early identification.

Market Equations India offers Medical Claims analysis services to healthcare providers to help them avoid losses by identifying members with a high probability of incurring high medical costs and help them develop strategies to take preventive action through early identification.

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Market Equations helps a large Insurance provider in the US with their medical claims and customer demographic data to provide real time insights helping them develop a preventive claims management strategy.

Objective:

The main objective was to lower existing costs incurred as well as develop a reliable and highly intellectual offshore knowledge team that could add value to the existing models and increase the probability of success.

Approach:

Market Equations provided a unique solution, using logistic regression models on Medical data and customer demographic data to address the objective.

Outcome:

Our predictive models helped the client take preventive action by identifying individual members who have high probabilities of incurring high medical costs.

• Identification of members with Diseases
• Sorting of members based on Disease maturity/condition
• Identifying and Analyzing Gaps
• Prevention through early Identification
• Cost estimation and Prediction - Probable High cost members, actual and predicted costs

Insurance Claims Analytics to help identify application fraud

Market Equations helped a large insurance company in the United States develop an analytics based scoring engine that identified fraud and suspicious claims thereby, helping them take corrective action in real time.