A large U.S. health insurer’s team specializing in identifying fraud and abuse was spending too much time manually running reports using multiple data sources to find outliers requiring further review. Investigators knew they needed to shorten the turnaround time to get these reports back to the requestor and minimize resources utilized to create these reports manually.
Human Ingenuity in Action
EXL Health created a dashboard highlighting all the required claim summaries, as well as member and provider data to evaluate potential issues. The resulting report could then be easily shared with other parties assisting with the investigation. The client realized $250,000 savings from reporting automation and is now able to investigate more providers and identify potential fraud much faster, resulting in an estimated savings of $2 million annually.
Why EXL Health?
EXL Health combines deep domain expertise with analytic insights and technology-enabled services to transform how care is delivered, managed, and paid. Leveraging Human Ingenuity, we collaborate with our clients to solve complex problems and enhance their performance with nimble, scalable solutions. With data on more than 260 million lives, we work with hundreds of organizations across the healthcare ecosystem.
To learn more about EXL Health, visit exlservice.com/health.