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

  • ML & Data Science Solutions: Build, Buy or Outsource?

    Data and analytics leaders increasingly believe that data science is a critical component of their analytics and business intelligence (BI) modernization plans, and are clamoring to incorporate new. Technologies such as predictive analytics, machine learning and deep neural nets sit at the Peak of Inflated Expectations on related Gartner Hype Cycle. While some degree of backlash […]

  • IIT Kanpur introduces Master’s programs in Cybersecurity

    IIT Kanpur has introduced three new cybersecurity postgraduate programs with intent to to address the need of cybersecurity personnel by ensuring training of dedicated and highly skilled manpower.   With a view to meet the shortfall in trained and skilled cybersecurity personnel in the country, the Indian Institute of Technology, Kanpur has decided to introduce […]

  • 2020 marked a “turning point” for Cybersecurity in Australia

    Australians are on high alert about the threat of cyber attacks following Prime Minister Scott Morrison’s warning in June that Australia was targeted by a sophisticated “state-based” cyber-attack. It was, according to the Australian Cyber Security Centre (ACSC), the most significant and coordinated cyber-targeting against Australian institutions to date. The Prime Minister said while such […]

  • Give AI a ‘positive’ spin: Google tells its scientists

    Google has reportedly been telling its scientists to give AI a “positive” spin in research papers. Documents obtained by Reuters suggest that, in at least three cases, Google’s researchers were requested to refrain from being critical of AI technology. A “sensitive topics” review was established by Google earlier this year to catch papers which cast a negative […]