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Case Study Intelligent Automation and Power BI Helps a Major Insurance TPA to Automate Insurance Approvals

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The Situation

One of the world’s largest and most reputed IRDAI Licensed Third Party Administrator (TPA) in the healthcare sector, was looking to improve its customer service by settling claims faster. To achieve a better Claim Settlement Ratio, the company needed to maximise operational efficiency and find smarter ways to combat fraud.

What Data Semantics Implemented?

The client now uses a system that automatically scans and segregates high volumes of financial data for suspicious account behaviour and notifies the risk team in time to act.

The client can automatically audit and scrutinize 100% of their claims in real-time and initiate a workflow on high-risk claims.

Detection of fraudulent claims have gone up by 200%, with full insights on suspicious accounts, behaviours and patterns.

The client’s risk team is now more equipped with data than ever before.

As a result of the solutions deployed, the client now saves 20% of its time in identifying and scrutinising fraudulent claims.

The deployed solutions have improved productivity and efficiency of the process by 200%, along with end-to-end visibility to the higher management.

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United States of America

info@datasemantics.co

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United Kingdom

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