Start now. Prove the value of Rules.

To the insured, when it comes to claims it’s all about speed.  For the insurer, it’s all about volume and accuracy.  Insurers know that small changes in policies can have significant effects on their business, positively or negatively.

Business Rules make your systems smarter and your processes faster, with greater accuracy. Plus, a high-performance scalable Business Rules server will keep up with your most demanding performance needs. 

• Data Enrichment
  • Pre-process raw claims data to improve accuracy
  • Create your own value-added member and provider matching routines without programming
• Auto Adjudication
  • Identify a subset of claims for special rules-based processing
  • Perform sophisticated examination of claims without modifying your existing claims system
  • Automatically document each claims decision
• Fraud and Abuse Monitoring
  • Quickly modify fraud detection algorithms
  • Identify new trends and create new alerts
• Examiner Controls
  • Integrate with your workflow system to provide enhanced control
  • Change work assignments and authority levels in minutes

Claims Processing and Recovery Solution Benefits Summary

• Increase the value of enterprise applications by extending their functionality
• Quickly adapt to changing conditions with rules-based processes
• Lower administrative costs due to manual processes and re-work