Healthcare Insurance Analytics

Insurance in healthcare is widely sought after, and has a large user base across the world, thanks to its universal usability. Unfortunately, tasks and procedures can bog down a typical insurance agent in routine activities and can lead to a lack of connection between on-ground and strategic direction. Healthcare Insurance Analytics comes in to bridge this gap, differentiating the wheat from the chaff. Here’s what you should consider that analytics offers.

Enrolment Metrics

Enrolment Metrics

The start of a member and insurer’s journey begins with expressing interest with a particular provider. Enrolment metrics gives you deep insights of member’s preferred plans and providers. In this industry, maintaining the right balance between promises and bottom lines can be tricky. While one provider might be killing it with discounted or incentivized plans, you might be wondering how they are able to pull it off.

With the preferences that members share, inputs like age, demographics and geographical are factored in. Enrolment metrics helps you group these members either with single or multiple input characteristics. It then allows you to sort members from the highest to the lowest chances they could purchase your plan. Members with low or no yield-potential can be studied closely, and changes can be made to plans.

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Encounter Metrics

Encounters go a step further than enrolment because it occurs when a member meets a provider. This is the first real interaction brands get to have with prospects. Therefore, it becomes a critical stage of the selling process.

Encounters could be successful, not just based on the strength of the health plans, but on the selling method too. Encounter information should be fed to health insurers to firm their databases, and focus on downstream processes.

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Encounter Metrics
Claims Metrics

Claims Metrics

Claims are the term that captures what insurance is about. A very important element, it is deeply tied to encounters, filing, and payments, while being the main communication medium between members and providers. It is the core of healthcare, and if strategized well, it can become the single biggest customer delight aspect, leading to revenue growth. Let’s see what claims metrics offers.

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Payment Metrics

Payment or remittance is a key element of the insurance process and begins with the premium paid every month by the member, to approved payouts, post an incident. We dive deep to offer insights into this important element as well.

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Payment Metrics
Fraud-Abuse prevention

Fraud/Abuse prevention

Analytics has helped industries battle benefits being misused. And this cannot be exemplified more than in Insurance Analytics. Since insurance is an industry that is fraught with significant fraud and abuse cases, analytics comes to your rescue, discovering suspicious trends and activities by providers and members. Now stay aware of fraudulent activity happening right under your watch.

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Utilization Management

Services can be raised through claims. But they cannot be executed without due diligence giving the thumbs up. In an expensive sector like healthcare, and insurance which is linked, the stakes are high. Utilization Management will help you empower your decision making, by driving insights into the path to that decision.

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Care Management

Care Management

What is more important than the healthcare industry taking care of patients, rather than prolonging service, and increasing chances of hospitalization, or worse? Care management analytics is a very important prevention tool, helping you balance medical services and cost of operations. Dive deep into this tool, and build actions based on insights that show you an overview of patient care vis-à-vis medical services.

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Provider Management

Providers are the most important stakeholders in the health insurance domain. They execute insurance delivery and provide competitive offerings to users. Provider Management encompasses them into a simple, comprehensible interface for you to manage and get the most out of them. There are many KPIs, but some are derived out of the providers.

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