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