Our client, an integrated healthcare company providing private health insurance and health solutions to 3.9 million people in the Oceania region was faced with the challenge of administrating numerous fraudulent claims made by healthcare providers, such as doctors. The claims which included excessive billing amounts, excessive number of patients per doctor and excessive number of tests per patient, are notoriously difficult to assess and manage.
Our dedicated team at Tecknoworks designed a powerful and highly scalable computational engine as well as a professional and easy to use interface with extensive reporting functionalities.
Our solution imports and maps large sets of data and assigns each doctor to a fraud risk category, being a very effective tool for both preventing and solving insurance fraud.
Type of solution: Advanced Analytics
Client Industry: Healthcare
Technologies: Miscrosoft SQL Server C# VBA Microsoft Excel Microsoft Access