Health Insurance Data Analytics

FAQ'S

1. WHY do you need Data Analytics ?

When we have large data it is extremely difficult to analyze every claim, inspite of best efforts there are possibilities that claims may be settled on cases which require additional checks and validation. Data analytics helps business by interacting with Big Data and provide insights into Health Insurance claim analytics. 

• Intelligent Interpretation of Business 
• An information that exists never unleashed 
• Greater Insights into critical and Hardening Areas 
• Risk involved in existing Data 
• Corrective Action 
• Future Trends 
• Cost Benefit

2. How does it help in detecting suspicious claims or detecting frauds? 

There are various parameters set inside the system which will flag records to be taken up for further analysis, Ex : Spikes in specific months when there was no known medical peril, Limit utilization in Domiciliary claims wherein maximum spend relates to Pharmacy etc., In one of the analysis we found that dental cases were at an alarming % compared to Base!! 

3. Do you provide Analytics as a service?

Yes Analytics is provided as a Service and usually the turnaround time is at least 5 working days. 

4. Have you ever covered Big Data for Health Claims? 

We have done couple of assignments and suggested remedial measures.

NOTE: This guide is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice.. All rights reserved, TransAsia Soft Tech)