Healthcare

Healthcare

Know Your Member provides a comprehensive, cross-validated, 360-degree profiling of members (beneficiaries) to ensure that only the truly eligible benefit from healthcare programs.
Effectively prevent recipient-fraud with world-class member profiling

Know Your Member (KYM) empowers healthcare payer(s) to ensure that only the genuinely eligible members benefit from healthcare programs & initiatives. KYM gives a comprehensive picture of the member’s background, including (but not limited to) any past or ongoing law-suits, prisoner records, capital gains, dual benefits, inheritance and exceptions, thus assisting the Healthcare payers in 360-degree scanning of the case and make informed decision about beneficiary inclusion.

Some of its

Smart Case Management

Allows the supervisor to consider the case analyst’ expertise, inclinations and current workload before assigning a case. Features such as linked applications, related messages & documents and recorded findings allow easy review of the case at any level in the work flow.

Elastic Security

Enables users / analysts to securely and instantaneously share a particular section / part of the page / the entire beneficiary’s application with colleagues to record their observation with limited privileges and time-frame. Allows case workers to add their comments, make attachments and record findings right at the attribute level which can be seen / referred by all relevant stakeholders

Intelligent Risk Scores

Earmarks beneficiaries / case at the first instance of any suspicion. The Risk-radial plot (first of its kind in any of the B2B application in the world) enables the users to quickly form a constructive opinion about the case through the risk ingredients, their contributions, etc. thus revealing the beneficiary’s specific susceptibilities.

Interactive Dashboard

While providing a comprehensive summary of all the cases in terms of workload by age, risk event categorization and social activity, it allows the users to drill down to the last level of detail on a any specific case attribute with ease.

Capabilities

  • Social collaboration Supports secure message exchange with Enrollment departments, and application sharing with related user accounts
  • Intelligent Risk Score Scores the beneficiaries for risk, based on their historic transactions, background checks and propensity to commit fraud
  • Beneficiary 360 Find out beneficiary affiliations, relationships, historic details and much more
  • Social Share Secured sharing of cases with colleagues / experts with complete control on access privileges
  • Resolutions Take action(s) on beneficiaries such as account suspension, letter generation seeking information, etc
  • Smart Reports Highly customizable reports enabling drill-down to the last level of information cascade
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