InsightPro Demo
CLAIMS FEATURES

Work Distribution

Efficiently assigning work based on roles and resources.

Inventory Management

Real-time tracking, aging analysis, and capacity utilization.

Auto Triaging/Deep Learning

Deep learning to categorize and prioritizing incoming claims.

Target Management

Data insights enable precise goal-setting.

Optimized Workflow

Reducing manual effort and minimizing the risk of inaccuracies.

Production Forecasting

Informed decision-making and resource utilization optimization.

Production Planning & Control

Precise capacity planning for seamless resource utilization.
 
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QA FEATURES  

Sampling

Enhances the precision and reliability of quality checks within the operational framework.

Inventory Management

Tracking for automated inventory replenishment according to defined rules and capacity.

Work Distribution

Using AI/ML to allocate samples to analyze experience, line of business, costs, and other parameters.

Criteria-based Audit

Seamlessly evaluation compliance with predetermined criteria for different types of samples.

Audit the Auditor

A proprietary process that conducts multiple levels of audits at each stage.

Real-time Error Feedback

Enhances responses with automatic notifications and dynamic interactions that amplify audit precision.
 
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CSR FEATURES  

Work Summary

Summary of the previous work day so Customer Service can start off strong with an overview of their performance and responsibilities.

Call Kick-off

Structured and efficient way for Customer Service to initiate and document calls with members and providers.

HIPAA Verification

Ensuring that health-related information is accessed and shared only with authorized individuals.

Member Landing Page

Member demographic information, eligibility/claims/billing information and call history information.

Call Reason

Call documentation and categorization to help manage inquiries based on the nature of each call.

Quick Reference/Actions/Views

Real-time access to information and streamlined communications across departments.
 
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Work Distribution

InsightPro encompasses two work distribution approaches to enhance flexibility and efficiency, catering to various work types and optimizing resource utilization.

After records/documents are ingested via API or Service into the Queue(s), there are two basic ways of distributing them:

1. Manual Distribution Based on Resource
Users pick what they want to work on from any assigned work Queues. There are two variations, depending on whether the work is assigned to the OHB (Over Head Bin – a repository of documents/records) or to personal work Queues.

2. Automation Distribution Based on Rules
The work in the Queues can be allocated and intelligently assigned based on predefined rules using atomic distribution. Strategically group work based on LOB, Claim Type, Aging, TAT, Priority, Pending Inventory, and Errors – then assign work based on the user roles, expertise, and permissions of the resource(s).