Artificial Intelligence solution to review claims instantly via an API integration to any Administrator's Claim Form and an interactive dashboard that presents results immediately as claims are reviewed.
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In a recent case, ClaimScore was utilized to compare the results of an Administrator's fraud analysis. ClaimScore was 78% more accurate, which prevented over $3M in fraudulent claims from being paid; and over $40M in total savings.
We have combined a 65+ point expert-system artificial intelligence algorithm with a neural-network machine learning system to ensure the highest level of accuracy possible; literally beyond humanly possible. This accuracy is stacked on a complex cloud-architecture that can live review 1,000's of claims/second, indefinitely.
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Case stakeholders are able to review up-to-the-second claim results in our proprietary interactive dashboard. The dashboard includes a summary of approved class members, units/claims, and payout amounts. In addition, a summary table of all claimants is provided with the claim results, deduction codes, and payout amounts.
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Users can filter data sets to drill down into specific claim cohorts. Once filters are applied users can choose to download Raw CSV Data files containing all details about each claim or PDF Insight Reports to get a more visual and statistical analysis of the case. Insight Reports provide aggregated results of valid and invalid claims, a timeline of claim submissions, as well as top claim sources and top deduction codes for spike timeframes.
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