Posts tagged as:

claims

Some thoughts on Next Generation Warranty Systems

March 2, 2009

I am going to speaking next week at the Warranty Chain Management Conference (registration is still open) on Next Generation Warranty Systems. I hope to post a couple of product reviews (like the SAS Warranty one already posted) this week but I thought I could also talk a little about my topic.
The basic premise is [...]

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SAS Warranty Solutions First Look

February 26, 2009

Some weeks ago I got a chance to review the SAS Warranty Analysis product. I was doing some due-diligence before my speech on “Next Generation Warranty Systems” to the Warranty Chain Management Conference in April.  The folks from SAS began with an Aberdeen quote from 2006:
Warranty analytics is the number one differentiator between Best in [...]

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High-Performance Scoring of Healthcare Data

February 19, 2009

Syndicated from Smart Data Collective
Natasha Balac from UC San Diego and Michael Zeller from Zementis (their product was blogged here and their support for the amazon.com compute cloud was discussed here) presented on the use of Medicare and Medicaid data to detect and prevent fraud. The high computing center at UC San Diego (San Diego [...]

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The High ROI of Data Mining for Innovative Organizations

February 19, 2009

Syndicated from Smart Data Collective
John Elder presented a collection of case studies to showcase the ROI of data mining. John started by making the point that many of his case studies had technical success but not business success – an interesting statistic. John sees three major ways that predictive analytics can help – streamlining, eliminating [...]

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DIALOG Improving Customer Experience in Health Insurance

February 5, 2009

Gerhard Hausmann presented on Barmenia and their use of business rules to improve customer experience. Barmenia is a private health / life insurance company in Germany with more than 2M contracts and 1.5Bn Euros in premiums. Been in business since 1904 and still have contracts that date back to the last century. In Germany there [...]

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Mr Obama, smarten these systems!

January 20, 2009

Like millions of my fellow Americans I listened to our new President today. As I did I was struck by the opportunities for decision management to deliver the smarter systems that will be critical with some of the priorities President Obama laid out in his speech. There were four commitments he made that struck me [...]

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Fraud Detection with Oracle Data Mining

December 3, 2008

Charlie Berger and some others presented on using data mining for fraud detection. Fraud is a huge issue – for instance there is $31B annually in insurance claims fraud (10-15%) with 25% of all claims have some fraud and more than 1 in 3 bodily-injury claims from car crashes involving fraud. Other industries have similar [...]

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On the importance of holistic decision making

November 6, 2008

I was chatting with someone the other day who shared a story of a European health insurer.   Their decision-making in claims looked only at the validity of the claim and nothing else. This of course created a situation where good (and very profitable customers) could be treated correctly but ineffectively – such as one [...]

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Integrating Predictive Analytics and BRM to Improve Health Plan Member Experience

October 30, 2008

Two gentlemen from Deloitte presented Integrating Predictive Analytics and BRM to Improve Health Plan Member Experience. 80% of healthcare costs are incurred by 20% of members and traditionally the 20% get all the focus. Analytics and data mining get applied to claims, authorization, costs as a result. Segmentation focuses on the unprofitable and unhealthy. Increasingly [...]

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Rules and Process Management for Insurers

October 28, 2008

Chubb has been working with Blaze Advisor to automate a number of decisions. They began with specialty lines underwriting (automated renewals), claims severity calculation and work queue assignment. Current focus is on integrating predictive models and some legacy modernization.
The automated renewals project reduced the time to make renewal rule changes from 3-6 months of IT [...]

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Live from InterACT – Insurance in the 21st Century

April 28, 2008

After lunch I joined the Insurance track and listened to Don Light of Celent (who wrote this nice paper some time ago) and Mike Gordon of Fair Isaac. Mike started and his first slide was headlined “survival of the fittest” which seems like the right headline! There is clearly a lot on in insurance these [...]

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Live from DIALOG – Breakthrough in Claims Excellence Management

February 26, 2008

Last session of the day was from Rodolfo Viola of Swiss Medical Argentina on Breakthrough in Claims Excellence Management. Claims is, of course, a prime target for rules-based automation so I was excited to hear how an organization outside of North America/Europe was handling it.
Swiss Medical is a privately owned company founded as a clinic [...]

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Book Review – Competing on Analytics

February 26, 2007

Competing on Analytics: The New Science of Winning by Tom Davenport and Jeanne Harris
Tom and Jeanne have written a new book (building on a paper they wrote some time ago) about what they call “analytic competitors”, that is to say companies that use their analytic prowess not just to enhance their operations but as their [...]

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