Health Insurance Claim Analytics

Health insurance is a numbers game. Payers/plans who can swiftly identify trends in the constant flow of data are better able to monitor risk, manage claims, and detect fraud. Failure to do so can lead to inefficient claims processing and increase in operational costs. With UBTI’s Health Insurance Claims Analytics, payers/plans can leverage interactive visuals and drill down details all in one place. This plug-and-play solution has been developed based on our two decades’ experience making it easier for health insurance providers to make timely, data-driven decisions. In essence, the solution helps you quickly identify business opportunities and risks so you can act on them. The solution equips management team with access to key metrics, accessible from their computer, tablet, and smartphone, and enables them

• Access key claim statistics in the dashboard
• Identify fraudulent claims and reduce losses
• Monitor claim amounts, monthly premiums, and loss ratios
• Detect provider-related claim abuse

Key insights uncovered include:

• Claim amount vs premium analysis comparison
• Procedures with maximum fraud outlier level
• FAMS trigger – insurer and provider city mismatch
• Most expensive procedures and diagnoses
and many more...