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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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WORKLOAD MANAGEMENT

Heightened Efficiency Dedicated to Healthcare Work Environments

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Workload Management

Explore latent opportunities within healthcare settings. Acquire crucial insights encompassing personnel, procedures, and technology in order to start fostering heightened efficiency, risk mitigation, workflow optimization, and the cultivation a health-conscious work environment.

  • Leverage InsightPro’s analytics to identify bottlenecks and streamline workflows, ensuring efficient resource allocation and task assignments for peak workforce performance.
  • Utilize InsightPro to assess skill sets and experience, guiding strategic resource realignment to maximize employee potential and cultivate a versatile, high-achieving workforce.
  • Employ real-time insights from InsightPro to monitor workforce productivity, driving proactive adjustments and tailored coaching for ongoing performance refinement and operational excellence.
  • Optimize task distribution through advanced algorithms, factoring in task importance, employee tenure, and expertise which leads to effective resource use and timely task completion.
Inventory Management-Claims

Inventory Management-Claims

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A comprehensive deep dive into daily inventory by following the lifecycle of all records, spanning from creation to disposition, to identify monthly trends, empower intelligent decision-making, and reduce manual tasks.