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 unnecessary operational costs.

With UBTI’s Health Insurance Claims Analytics, payers/plans can enjoy 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, modern business intelligence (BI) helps you quickly identify business opportunities and risks so you can act on them.

• Insightful dashboards – oversee claim statistics in a single screen

• Fraud analysis – identify fraudulent claims and reduce losses

• Loss ratios – view claim amounts, monthly premiums, and loss ratios

• FAMS triggers – enables insurers to identify provider-related claim abuse

• Claim amount vs premium analysis with loss ratio  

• Procedures with maximum fraud outlier level

• FAMS trigger – insurer and provider city mismatch

• Most expensive procedures and diagnoses 

• … and many other useful metrics 

For more information, please contact info@ubtiinc.com.