Predictive analytics can help insurers improve claims performance—a vital lever
of high performance in the insurance industry. The claim is the defining moment
in the relationship between customers and insurers. When the claims process is strong,
insurers can operate more efficiently while providing a superior customer experience—thereby
protecting revenue and profitability. Yet the hurdles are many: customers are becoming
harder to please, fraud is a constant issue and efficiency can be elusive. As a
result—and despite its importance—many insurers are falling short on claims performance.
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Through role-based productivity & insights, Insurance operators can draw insight from a vast amount of business-related data and maximize the productivity of workers. Capabilities include real-time analytics, which offers rich statistical and analysis packages for data mining, discovery, and reporting for diverse information faculties-customers, and complex event processing, via capabilities of Big Data Analytics on cloud or on premise, and using Complex Event Processing technology. Differing software tools and systems that workers use daily should be seamlessly integrated to allow for continuous importing and exporting of business data from one system to another in order to complete workflows. They should also be able to perform detailed ad-hoc data analysis and other business intelligence functions on their own and without, for example, having to define a report and request their IT to provide it for them using powerful, easy-to-use tools like Dashboards, Scorecards, KPI and custom reports, and in-memory fast access information. These principles also include methods for storage and master data management of repositories to capture and enable analysis of operational and business data – located on-premise, in the cloud, or a hybrid mixture of both.
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By understanding enhanced user experience, the host insurance Company understands how participants experience the world and how technology fits into that experience. New technologies take advantage of rich user experience, intuitiveness and ease of use across a multitude of devices – from smart phones and tablets to PCs and expansive operations command centers. New programming technologies, such as Windows Presentation Foundation, Silverlight or HTML 5, are opening new possibilities for applications in the business domains that run on many form factors. Intuitive interfaces now feature rich, composite dashboards and are accessible from mobile devices. These interfaces also incorporate natural human interaction with the software allowing workers to use gestures, voice, and touch.
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Collaboration allows people to work together more closely, coordinate their efforts,
follow detailed business processes, and respond to events as they happen. The Healthcare
industry will require even-greater collaboration to account for a globalized and
evolving workforce, as well as increasingly complex and mission-critical exploration
and production. Communications technology is keeping pace with today’s global and
on-demand collaboration – including real-time communication networks, mobility,
Web conference, voice over IP (VoIP), and of course, social media. Dss Solutions
Collaboration services framework support them by utilizing Microsoft technologies
that may include Lync,
SharePoint and
Office 365.
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Collaboration allows people to work together more closely, coordinate their efforts,
follow detailed business processes, and respond to events as they happen. The Healthcare
industry will require even-greater collaboration to account for a globalized and
evolving workforce, as well as increasingly complex and mission-critical exploration
and production. Communications technology is keeping pace with today’s global and
on-demand collaboration – including real-time communication networks, mobility,
Web conference, voice over IP (VoIP), and of course, social media. Dss Solutions
Collaboration services framework support them by utilizing Microsoft technologies
that may include
Dss Solutions offers many partner tools and technologies to help solve the interoperability
issues for our customers. Many of these tools and technologies follow open industry
standards, such as Simple Object Access Protocol (SOAP), OData and Web services.
Some of the technologies offer data-based integration and others offer document-based
integration or a hybrid of both. Some of the tools that Dss Solutions utilized and
offered by Microsoft that support a Connected Business include BizTalk Server, Windows Azure Service Bus, Windows Communication Foundation.
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The framework Guiding Principles capture the need of an underlying technical infrastructure
that at the foundational level enables many business processes. Principles of this
infrastructure include scalable support for more users, larger models, and increased
transaction volumes; securely deployed components, functionality, and information
protected from unauthorized access or malicious attacks; and services that are location
agnostic for anywhere deployment and which can be accessed on any device. Integration
through messaging and database technology links together workflow, processes, and
data optimization. Domain-specific infrastructure incorporates trade-specific infrastructure
connections using unified communications to manage enterprise security. A secure,
scalable, high-performance infrastructure should also take advantage of global high
availability, app and data marketplaces and software as a service.
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Improving claims has become an increasingly critical challenge for insurance companies
around the world. Indeed, within the global insurance industry the claims function
occupies a unique place in determining competitiveness: it represents nearly 80
percent of the premium, and it is where the company either delights or disappoints
customers. However, despite the importance of claims in attracting and retaining
customers and maintaining a healthy balance sheet, many insurers are falling short
on claims performance—as evidenced by a variety of measures, including customer
satisfaction, leakage and overall inefficiencies.
The time has come for insurers to take a more holistic look at improving the claims
process—and the important role that predictive analytics can play in transforming
key aspects of claims to help drive sustainable growth and high performance.
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Underwriting and pricing: Find gaps in traditional risk assessment and underwriting
methodologies, and thereby, provide novel ways for insurers to better distinguish
between seemingly similar or identical risks. Including analytics in an automated
underwriting platform can help improve the quality of the underwriting as well as
speed up policy writing and reduce operating expenses.
Talent management:Psychometric data, which is used to measure an employee’s
strengths and weaknesses, can predict employee performance. We found that employees
with certain combinations of behavioral traits had twice the chance of being promoted,
whereas employees lacking a different combination of traits had virtually no chance
of being promoted
Medical malpractice prediction: Predictive analytics can help insurance companies
better determine whether doctors, are more likely to be sued for malpractice based
on practice parameters and patient safety.
Consumer business: Analytics can help insurance carriers understand their
customers as well as sales patterns better, Mills notes. Although it’s extremely
effective, many companies use their data “only to generate business metrics and
fairly standard management reports. The data exist but are not being used to refine
decisions rooted in intuition and mental heuristics.
Claims and medical case management: Medical case management models, combine
medical (diagnoses and co-morbidities), biographic, demographic and psychographic
information to more effectively predict which cases are more likely to exceed industry
standard norms for severity and duration. With improved case management tools like
these, workers can be helped to return to work more efficiently and abusers of the
system can be more easily identified.
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