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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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WORKFORCE MANAGEMENT

Actionable Data on Valuable Metrics such as Workload, Efficiency, and Resource Allocation

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Workforce Management

Harness real-time production insights to enhance healthcare workforce management. Gain actionable data on key metrics such as workload, efficiency, and resource allocation. Empower teams and decision-makers with dynamic analytics to address issues, optimize resource allocation, and ensure timely service delivery, ultimately elevating overall healthcare performance.

  • Harnessing team insights, we provide personalized suggestions to optimize work balance, boost productivity, and elevate efficiency within your team.
  • Stay updated with weekly coaching insights, uncovering opportunities for strategic improvements.
  • Implement tailored guidance, fostering enhanced work habits and encouraging collaborative dialogues.
  • Evaluate the influence of guidance through week-to-week progress reports on performance and habits.