India's largest platform and marketplace for AI & Analytics leaders & professionals

Sign in

India's largest platform and marketplace for AI & Analytics leaders & professionals
Become a Thought Leader
Become a 3AI Member

Sign in

3AI Digital Library

< Go Back

Claims Subrogation Analytics

3AI August 15, 2020

Leading US Health Insurance Company

Problem Statement

  • Annual revenue leakage because of subrogation non-recovery: ~ $79.2 MN
  • Subrogation recovery rate: 4 %
  • Business objective was to analyze closed subrogation cases and identify case segments having high propensity of recovery, so that focused attempt can be made to recover them

Analytics Led Approach

  • Given are high level process steps which were followed

    • Distribution analysis ; Correlation analysis ;Anova
    • Original Amount, LOS, Age, Units Billed, DX (transformed) ; # of Claim Lines
    • Test, Control split ; Logistic Regression model development; Model selection
    • False positives, true negatives comparison for cut off determination
    • Insights and business rules formulation

Business Impact

  • Predictive analytical model was designed to identify case segments having high propensity for subrogation recovery
  • A systematic approach to transform the model results into business rules, that can augment current subrogation process making it more effective was framed as well

Critical Success Factors

  • A potential recovery rate increase of 8% – 22 % for cases with >60% of subro potential
  • Opportunity to plug in revenue leakage of USD ~5 MN has been addressed
  • Additional business rules to prioritize cases for subrogation recovery that can seamlessly integrate within existing workflow

    3AI Trending Articles

  • SolarWinds cyber attack: Catalyst to rethink Federal Cybersecurity

    Federal chief information officers and chief information security officers didn’t get a lot of sleep last week, and may not for the foreseeable future. CIOs and CISOs have spent a long week trying to get a handle on the impact on their networks, systems and data from the SolarWinds cyber attack. After the Department of Homeland […]

  • Driving AI Adoption: An 8-Step Blueprint for Your Team’s Success

    Featured Article: Author: Ganes Kesari, Innovation Titan A Telecom major was grappling with high customer attrition. The firm was one of the largest Telecom companies in the world and a market leader in Asia. The marketing team’s heuristics-driven approach to customer retention was dated and ineffective. Reviewing the business performance in a weekly huddle, the […]

  • Upskilling into AI

    Featured Article: Author: Puneeth B C, Computer Vision Specialist, Airbus India AI has penetrated our lives in a way that sometimes we don’t even realize. Devices and applications we use, are becoming smarter every day. An AI system knows more than what we know of ourselves. It is faster and more accurate than us in […]

  • Impact of AI on Data Anonymization

    Featured Article: Author: Mohan Khilariwal, DGM, Data Engineering, Analytics and Data Science, HCL Technologies Data anonymization has become much more critical as we are into the era where data sharing is becoming a necessity in order to serve the customer, new business opportunities, Governments want to take help from the industry to serve its people […]