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HEALTHSCIENCE
Payer Analytics

The healthcare organizations in US are grappling with managing the growing gap between human needs and financial resources. Aging population in advanced countries is demanding more and better care, while the cost of care is surging. The changing demographics combined with rising consumerism and increased competition is forcing payers to look at advanced analytics tools to provide healthcare business strategists the power of complex decision making with high degree of accuracy to contain costs and yet enable members access to best quality care. These analytical models help in

Increasing operational efficiency by

Reducing billing errors
Managing claims in time
Managing Fraud and abuse

Deriving financial strategies

Deriving profitable plan designs
Optimal benefit pricing and design

Evolving business strategies for

Contracting strategies
Identifying cross selling opportunities
Increasing customer satisfaction and retention

Wipro’s business Intelligence and analytics solutions help payers meet the above goals, by focusing on

1. Validating the precision bias and stability of quality performance indicators
2. Aligning best practices policies within and outside the organization, making a huge difference in the efficiency of routine operations
3. Providing visibility and complete granularity on various processes needed to plan and execute accurate operations.

Payer analytics provides service in seven key areas

Member Analytics

Member satisfaction analytics
Demographic market segmentation
Outcomes analytics
Risk pooling and monitoring
Consumer innovation

Provider Contracting

Reimbursements optimization
Contract Analytics
P4P Analytics
Credentialing Analytics

Underwriting Analytics

Health benefit pricing
Risk solvency
Actuarial and pricing models
Reserve calculation

Financial Analytics

Rate filing analytics
Capital Analytics
Spend analytics
Performance evaluation
Reserve analytics

Regulatory Analytics

Rating mandates analytics
Product and benefit mandates
HIPAA preparedness
Impact of new regulation on business

Market Analytics

New product impact
Commercial market share
Distribution channel analytics
Service line analytics

Strategy and Planning

Market assessment
Financial analyses
Operational analyses
Claim analyses




 
 
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  CASE STUDIES
Web based enrollment and customization to facilitate consumer driven health plan
IT consulting for improving maintainability, scalability and interoperability of four payer applications
  More case studies
  IDEAS
Data mining: Mining for gold
Data quality - A problem and an approach
  More ideas

 
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