Efficient Mediclaim Process Management Through Text Analytics

A Mediclaim is a medical insurance which is a form of health cover that can reduce a person`s risk through a monetary form. The expenses such as the hospitalization charges, medicines, treatment fee, etc during the ailment can be reimbursed or deducted from tax payments through a Mediclaim policy.

Mediclaim processing is the entire process of applying for a medical insurance, submission of the necessary documents and claiming the reimbursement. There are two major types of Mediclaim policies- Cashless mediclaims & Reimbursement mediclaims.

Various unstructured data in Mediclaim insurance companies such as Policies, survey results, Claims & complaints, Electronic medical records, Clinical data- computerized physician order entries, physician notes, medical imaging records (CT Scan, MRI, Ultrasound, PET scan, Sonogram, etc…), Research registries, Treatment details and many more form 80% of the data in the medical insurance organisations. Handling this enormous unstructured data is a great challenge.

Starting from filing a client`s insurance policy till their claims management, the Mediclaim insurance firms spend long hours and manpower to segregate, store and process the information. Extraction, classification, categorization, detection, Effective Claim management, summarization of the information and other complex tasks can be processed faster and more efficient using text analytics software.

Text analytics uses NLP, ML and AI to process the unstructured data into structured data that can be used to derive insights. The entire process of Mediclaim can be made easy through sentiment analysis, entity recognition, categorization, key word extraction & identification and many more operations that can be performed using text analytics.

Research units of company’s employee text analytics techniques to analyse the text of insurance claims, settlement notes, etc in order to prioritise their study for the final settlement of claims.

For instance, organised frauds can be detected easily when claims from a multiple accident form a common pattern which is a clear indication of fraud.

Also Read: Voice Of Customer Analysis For The World`s Largest Sports Goods Retailer

When voice analysis of the customer is carried out on comments posted on social media networks, the trends, perception on the brand- sentiment polarity, the conceptual basics and the entities we are associated with, clearly giving an account of the deft differentiation of the parent brand with a competitive advantage.

In case the company`s reputation is at stake; it helps to put the company back on wheels with timely identification of deficiency.

Automatic classification of complaints according to the insurer`s products, their manner of service or operating mode from claimants will help in directing them to the right agents so that the treatment will be appropriate. It also helps in improvising decisions in the claim management process.

Data mining and text analytics solutions pave way for automatically extracting subrogation indicators from the reports by frauds.

overpayment on claims causes criticality in the recovery solutions. Identification, elimination and recovery of overpayments can be done using analytics solutions. A proper mapping and red flags in this process reduces the lead time for processing the claims.

Early intervention benefits high risk claims that require more attention and care and also processes lower risk claims faster through automation and auto-adjudication.

Identifying high risk claims and fraudulent claims facilitates payers to keep a better track of the claims that are being processed improving the overall efficiency of the claims processing thereby reducing costs.

The voice of the doctor/nurse can be recognised, and the system can understand the context and take notes in accordance to the text. Abbreviations, formula, equations and other complex texts can be recognised. This can be implemented with the voice of the patients too.

Text analytics can create chatbot facilities to replace call centres agents and receptionists. On a higher note, upgraded versions of chatbots as answering machines which can replace expensive visits to a doctor. Answering queries can be done more efficiently using these answering machines. Thus, the cost and time is saved.

To overcome the challenges owing to increased competition in claims management and claimant`s satisfaction, employment of highly efficient claims management systems using text analytics is the call of the day.

Our customized text analytics solutions are completely automated that can reduce the time of processing by 30% and can provide greater efficiency with minimum errors. teX.ai can extract, classify, and summarize unstructured data in any form (PDF, HTML, images, videos, audios, etc) and can understand 15+ languages to deliver the required insights

Looking to extract actionable insights from text data? teX.ai is your all-in-one solution for all your text analytics needs. Talk to us now.