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Insurance analytics to automate claim management in the US

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Automate health insurance analytics to reduce processing time and allow efficient insurance claim data analytics in the USA

The US healthcare sector deals with complex data, including electronic records and medical insurance claims. This makes hospital management a complex process. Billing and payment reimbursements from insurance companies can be cumbersome. Errors in medical coding can further create complications, thereby making insurance analytics a lengthy process. 

Medical bills and insurance claims are of significance to the health insurance companies and health centers in the USA. Both sectors strive hard to maintain a balance. Any disruption in claims data analytics can hamper either party. Insurance companies aim to work efficiently and satisfy their customers. Integration of data analysis in the insurance sector allows insurance providers to be strategic and achieve their goals. They can get an idea of the health insurance claim analytics, claim patterns, what’s happening, and identify the areas that need improvement. Healthcare automation with claims analytics through insurance claims software in claims analytics helps insurers identify external trends that can affect their claim outcomes, increase the insurance claim data processing time, and lower the processing cost.

John

john russo

VP Of Technology

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The Growing Challenges

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Cumbersome process

The medical insurance claim process in the US can take long durations because it consists of endless documentation and communication between patients, health centers, and claim providers.

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Data management

Health insurance claim analytics involves dealing with a lot of information, and mismanagement or lack of organization can create instability.

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Claim Errors

Manually handling insurance claim data can cause grave errors, such as mistakes in entering incorrect medical codes or patient information, and these can further delay the medical insurance claim process.

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Inefficient staff

If employees are unable to give their best performance, it affects healthcare claim analytics's efficiency and outcomes.

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Fraud

Health insurance fraud is a major concern in the US healthcare industry as it can lead to huge losses for insurance providers and the insurance benefits of patients

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Decreased performance

A lack of innovation and updated technology in healthcare claims analytics can reduce insurance companies' overall performance.

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Our Process

Automate Health Insurance Analytics to Reduce Processing time and allow Efficient Insurance Claim Data Analytics in the USA

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Solutions

Predictive Analysis with Automated Claim Analytics in the USA

Medical claim analytics involves tonnes of paperwork and back-to-back communication. As a result, data analytics in the insurance sector and the diagnosis of claim outcomes can slow down. Predictive analysis can perform health claim analytics and identify claims having the potential for high-defense costs. Predictive analytics in insurance combined with health claim analytics can simplify insurance claims data processing.

 OSP can create predictive analytics in insurance analytics that would facilitate real-time sharing updates of claims. Our customized insurance analytics assess claims before sending them to the payer companies. We can help you predict the possibility of claim approval against the actual value claimed. Our custom predictive modeling compares factors associated with new and pending claims with those of past losses. In this way, testing historical claims data from diverse insurance provider companies produce an algorithm that predicts the possible claim approval value. OSP’s insurance claims data analytics yield accurate statistics of the generated claims that further assist the traders in decision-making. 

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Claim management for fraud detection in the US

The Health Insurance industry in the USA is expanding with different types of policies being offered to patients. Health insurance fraud is a major crime in the USA, which could have severe consequences. A health insurance fraud refers to a situation where an insured or medical service provider produces fraud, false or misleading information to the insurer to obtain benefits from a policyholder’s policy.

OSP can develop insurance analytics integrated with claim fraud analytics solutions for identifying fraudsters and their intention of inflating claims for personal benefits. Our custom insurance analytics solutions can predict potential fraud through a fraud detection algorithm, so necessary actions can be taken on time. We can streamline the process of fraud detection and provide risk alerts, thereby improving claim analytics in insurance. OSP can mitigate fraud detection challenges and help insurance companies in the US address concerns of fraud claims.

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Loss ratio analysis in the US

The loss ratio in terms of claim analytics in insurance is a percentage that represents the ratio of losses incurred in claims and adjustment expenses relative to the premiums earned during the period. There are two main types of loss ratios in medical claim analytics: medical loss and commercial insurance loss ratios. The medical loss ratio means the ratio of healthcare claims paid to the premiums received. A commercial insurance loss ratio is meant for the insured, where the insured needs to maintain an adequate loss ratio, or else it costs a non-renewal of insurance or increased premium for the cover. 

OSP offers a wide range of healthcare business solutions, including insurance claims data processing. We can create insurance analytics to help calculate the losses incurred in claims. Insurance companies can estimate the losses or potential losses in their policies using our custom medical claim analytics. This will allow insurance providers to be in a better position of self-assessment. Based on the loss ratio analysis using OSP’s health insurance claims software, insurance companies can decide the premium cover costs. 

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Insurance analytics with contributory databases

Medical insurance claim companies have their data, policies, terms, conditions, market trends, and so on. If all this data is isolated within each company, each carrier can only view its portfolio. On the other hand, when carriers analyze market data, they can view their business concerning the market and gain new insights that earlier seemed impossible. A contributory database in insurance analytics means collecting health informatics supplied by insurance market members to a central repository that gets shared between the contributors. 

OSP can develop health insurance analytics with a contributory database that would add value to insurance companies by normalizing, standardizing, aggregating, and linking the market-contributed data with other information. In this way, carriers would derive revue growth and profitability, improve operational efficiency, come up with new concepts, and protect themselves against fraud. OSP’s customized claims data analysis can establish contributory databases that enhance insurance companies’ success and growth.

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Telematics through claim analytics in the US

Telematics in insurance analytics are methods for collecting information or data to offer personal feedback or cost savings on insurance policies. It provides rich data to support insurance companies in the medical insurance claim process or take the required actions. Insurance analytics software incorporating telematics can help fasten the processing of insurance claims, which is especially useful in emergencies that can save hundreds or even thousands of lives each year.  

OSP’s customized health insurance claims management software with telematics can give valuable insights and data on customers. Our claims analytics software with telematics consists of wireless communication, GPS, and other diagnostics that can help with real-time tracking of traffic conditions, risks, customer behavior, and lifestyle. We can develop insurance claims analytics software solutions integrating telematics to help insurance companies in the USA achieve better customer outcomes and improved operational efficiency. Insurance providers can also obtain an increase in revenue through OSP’s insurance claim data software. 

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Claims analytics using interactive dashboards and reporting

Insurance companies in the USA resort to data management to handle risks, build trust, and empower learning. Health insurance analytics is prone to face changes and sudden difficulties. Healthcare claims analytics can deal with such challenging situations through interactive dashboards.

 OSP can create insurance claim analytics solutions that can facilitate digital transformation and data-driven works to improve operations, customer experiences, and risk management. Our custom insurance analytics allows insurance providers to use data in ways that support better claim management, fraud detection, and lead to increased customer satisfaction. Insurance companies can visualize all data analyzed and prepare reports easily using analytics for insurance designed by OSP. These would enable the companies in quick decision-making.

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Client Testimonial

Stephen CarterCEO of sterling staffing solutions llc.

OSP has worked with Stephen to create a mobile health application offering 'Doctor on Demand'. This mhealth solution is based on the Uber model to enhance the availability of health access in the US.

What We Offer?

Compensation
analysis

Compensation in insurance analytics is a feature that needs thorough monitoring via automated features due to the large volume of claims in this arena. OSP's custom insurance analytics solutions identify the risk factors with compensation insurance specific to customers through data analysis. This insurance analytics approach avoids the expenses by conducting a risk analysis of inaccurate payments and suggestions for early intervention.

Healthcare Management
Social media
analytics

Social media analytics involves curating and analyzing data from various social media platforms, such as Twitter, Facebook, LinkedIn, Google+, etc. Insurance claim analytics by OSP can integrate social media tools to track data and assess online interactions and conversations with customers. Our custom social media analytics allows insurance companies to understand and reach the target audience and drive new customers. Insurance providers in the USA can also design specific marketing strategies to attract the target audience and optimize their websites and social profiles.

Diagnostic Support
Overpaying cases
settlement

Insurance companies in the USA adopt health insurance claim management strategies to settle claims and medical insurance claim denials quickly. As a result, it may lead to overpayment because of rushing to settle the dues. OSP can create customized insurance analytics using claims processing software that can examine and optimize data. Optimizing payouts would reduce the time of processing medical insurance claims and improve the efficiency of payments. Our system for managing health insurance claims data minimizes overpaying and decreases insurer costs through limited instant payouts.

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