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An integrated workforce analytics platform powered by AI and machine learning.
Claims Management Solutions
Reduce denials, improve first-pass rates and cut admin burden.
Quality Assurance Solutions
Integrate sampling, capacity planning, comprehensive auditing, and rebuttals.

Contact Center
Solutions

Improve First Call Resolution with AI-enhanced integration.

How It Works

Integration

Privacy & Security

Proven it will
pay for itself in
the first year.
Our integrated workspaces are designed to help you get more done, faster.
Claims Management Features
Enhance productivity, AI-powered distribution, and production planning.
Quality Assurance Features
Improve First Call Resolution, call history and cross-department integration.

Contact Center
Features

Robust error feedback, rebuttal workflow, and error trend analysis.
Work Distribution

Work Distribution within InsightPro exemplifies a quality-centric strategy that seamlessly integrates AI/ML capabilities with intelligent rules. The rules engine can be customized to allocate quality samples to auditors, considering factors like experience, line of business, dollar amounts, and other relevant parameters. This rule-based approach enhances efficiency, productivity, and the precision of audits.

Customizable Rules Engine:

InsightPro features a customizable rules engine that serves as the backbone of the work distribution process. This engine allows processes to define specific criteria and parameters for distributing quality samples. These criteria can include factors such as the experience level of auditors, the line of business, dollar amounts, and other relevant attributes.

Efficiency and Productivity:

By automating the work distribution process based on predefined rules, organizations can significantly improve efficiency and productivity. The system can handle the allocation of samples quickly and accurately, reducing manual effort and the risk of human error. This efficiency allows auditors to focus their time and expertise on conducting thorough audits rather than managing sample assignments.

Continuous Improvement:

The rules engine can be continuously refined and updated to reflect changing quality priorities and objectives. Processes can analyze the effectiveness of their distribution rules and adjust as needed to optimize the process continually. This commitment to continuous improvement contributes to ongoing enhancements in audit quality.

Criteria-based Audit

InsightPro introduces Criteria-based Audit, a foundational element of our comprehensive strategy to uphold both quality and efficiency. By configuring diverse audit criteria and calculating accuracy through a point-based system, we redefine the concept of quality. This innovative functionality seamlessly evaluates compliance with predetermined criteria for different types of samples. Conducting audits at a granular level, which minimizes errors, contributes to enhanced overall quality.

Diverse Audit Criteria:

Criteria-based Audit allows organizations to configure a wide range of audit criteria tailored to specific types of samples, processes, or quality standards. These criteria can encompass various aspects, such as accuracy, completeness, adherence to guidelines, regulatory compliance, and more. By defining diverse criteria, organizations can comprehensively evaluate the quality of different samples, ensuring that each criterion aligns with specific quality objectives.

Point-Based Evaluation:

The innovation lies in the point-based evaluation system. Instead of a binary pass/fail approach, where samples are simply marked as either compliant or non-compliant, a Criteria-based Audit assigns points based on the degree of compliance with each criterion. This point-based system offers a nuanced and granular assessment of sample quality. Samples receive scores reflecting their level of adherence to the defined criteria, providing a more detailed and informative view of quality.

Customizable and Adaptive:

Criteria-based Audit is highly customizable to suit the unique needs and objectives of organizations. Managers can define and adjust audit criteria as requirements evolve or as new quality standards emerge. This adaptability ensures that the auditing process remains aligned with changing quality priorities and compliances.

Audit the Auditor (Multiple Levels)

With a steadfast commitment to prioritizing quality, InsightPro introduces a groundbreaking concept called Audit the Auditor. This innovative approach involves conducting multiple levels of audits, incorporating crucial parameters at each stage. By implementing Audit the Auditor, we ensure a rigorous quality assessment process, fostering continuous improvement and heightened accuracy.

Enhanced Objectivity:

By subjecting auditors to their audits, it promotes greater objectivity in the auditing process. Auditors are more likely to adhere to standards and guidelines when they know their work will be scrutinized by their peers or superiors. Auditors are encouraged to learn from their audits and the feedback provided by their colleagues. This process can lead to the refinement of auditing techniques and the identification of best practices.

Increased Accuracy:

The rigorous nature of this approach can lead to higher accuracy in audit reports. Multiple layers of scrutiny can help catch errors or oversights that might have been missed in a single-level audit.

Continuous Refinement and Precision:

The dual benefits of Audit the Auditor are spotlighted: driving continuous improvement and enhancing accuracy. Through multi-level auditing, a feedback loop is established, fostering ongoing enhancements. This iterative approach refines quality standards and amplifies assessment accuracy, fostering a culture of perpetual refinement and excellence.

Real-time Error Feedback – AI/ML Based

Harnessing the power of AI and machine learning, Real-time Error Feedback brings benefits not only to examiners but also to auditors, indicating a new era in error detection and analysis. This transformative approach enhances the efficacy of responses by incorporating automatic notifications and real-time feedback mechanisms. These mechanisms engage both examiners and auditors across different levels, resulting in dynamic interactions that significantly amplify audit precision. In doing so, we reinforce our steadfast commitment to upholding exceptional quality standards.

AI-driven Advancement:

The technological leap of Real-time Error Feedback, powered by AI and machine learning, marks a pivotal stride. This integration signifies a significant advancement in error detection and analysis, embracing the forefront of technological progress.

Precision Enhancement:

Real-time Error Feedback’s impact on precision is transformative. Automatic notifications and real-time feedback mechanisms empower timely error resolution. These dynamic interactions create an engaged and informed auditing process, amplifying accuracy.

Data Analytics:

The data collected through real-time error feedback can be analyzed to identify trends and patterns in error occurrence. This data-driven insight can inform process improvements and training needs for both examiners and auditors.

Query Resolution / SME Support

Empower your auditors with the cutting-edge capability of AI-driven Query Resolution and Subject Matter Expert (SME) Support to address inquiries promptly and precisely, providing real-time assistance and expert guidance. This feature guarantees superior quality in resolving concerns and upholding seamless quality standards while resolving queries at different levels. What sets this system apart is its ongoing refinement through machine learning algorithms. This iterative process continually enhances the system’s ability to provide accurate query resolution.

Multilevel Query Resolution:

Provides access to multi-level query resolution support. In the initial stage, a chatbot or AI-driven system is deployed to attempt to answer the query. These systems use predefined algorithms and knowledge bases to provide immediate responses to common or straightforward queries. If the BOT is unable to answer the query satisfactorily, the next level of support involves providing guidance based on predefined guidelines or protocols. In cases where both the BOT and the guidelines fail to provide a satisfactory resolution, the query is escalated to a Subject Matter Expert (SME) for final resolution. These automated steps help address routine inquiries quickly, reducing the workload on human experts.

Immediate Assistance:

AI-driven Query Resolution and SME Support offer real-time assistance to examiners and auditors, ensuring that inquiries are addressed promptly and accurately. This reduces delays in the examination process.

Consistency:

The system maintains a consistent approach to query resolution, reducing the risk of human error or inconsistencies in responses. This consistency contributes to the overall quality of query resolution.

Rebuttal Management

Elevate error management and precision with InsightPro’s meticulously structured yet customizable rebuttal workflow. This feature effectively curtails the time required for error resolution from weeks to mere hours, eradicating the need for weekly meetings to address contradictory errors identified by the Quality team. Our workflow establishes an efficient feedback loop, facilitating error rebuttals through robust mechanisms and not only streamlines error management, but promotes rapid resolutions, and fosters a culture of continuous improvement within the organization.

Efficiency:

By providing a structured workflow for error rebuttals, the time required to resolve errors is significantly reduced. The transition from weeks to mere hours for resolution is a remarkable improvement, saving valuable time and resources.

Feedback Loop & Agile Resolution:

The rebuttal workflow establishes an efficient feedback loop between examiners and the Quality team. This loop ensures that errors are promptly addressed, and communication is clear, leading to faster resolutions.

Transparency:

The structured workflow promotes transparency in the error rebuttal process. Examiners and Quality teams can track the status of error resolutions, ensuring accountability and visibility throughout the process.  Streamlined processes and rapid resolutions foster a culture of continuous improvement. Robust mechanisms for error correction promote constant learning and refinement.

User Management

User and access management is a crucial component of quality management systems that empowers quality managers, acting as administrators, to effectively control user access and assign appropriate access rights to QA auditors. Through user and access management, quality managers can exercise granular control over who can access the quality management system and what level of permissions they possess. This ensures that only authorized personnel can access sensitive quality-related data and perform relevant tasks. By assigning access rights based on roles and responsibilities, the system maintains security and confidentiality while allowing team members to contribute effectively.

Empowering Quality Management:

User Management’s role in empowering quality managers as system administrators, granting control over user access and rights allocation to QA auditors.

Granular Access Control:

Precision in regulating system access. Quality managers exercise granular control, safeguarding sensitive data for authorized personnel.

Security and Collaboration:

Showcasing dual role in balancing security and collaboration. Access rights based on roles maintain collaboration while upholding confidentiality and security.