India's largest platform and marketplace for GCCs & AI

Sign in

India's largest platform and marketplace for GCCs & AI
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 […]

  • New Customer Expectations Driving Digital Innovation

    Featured Article: Author: Nitin Srivastava, Director – Data & Analytics, Advance Auto Parts India To ride this tide of disruption, it is crucial to understand the pulse of customer behavior and demand and integrate it into a digital first approach. One of the key changes brought about by the COVID pandemic was the acceleration of […]

  • Using AI to Outwit Malicious AI

    Robust Intelligence is among a crop of companies that offer to protect clients from efforts at deception. IN SEPTEMBER 2019, the National Institute of Standards and Technology issued its first-ever warning for an attack on a commercial artificial intelligence algorithm. Security researchers had devised a way to attack a Proofpoint product that uses machine learning to identify spam emails. The system produced email headers […]

  • New 2D tag with AI authentication to spot counterfeit products Faster & Accurately

    The authentication process takes under 3.5 minutes to complete, and involves scanning the tags under an electronic microscope to obtain the PUF pattern, which is sent to the AI-driven software for validation. A new anti-counterfeiting technique uses two dimensional (2D)-material tags along with artificial intelligence (AI)-driven authentication software, and promises to deliver faster, more accurate […]