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Fraud Analytics in Healthcare on DDP

Wipro Ltd

Identifies dominant factors leading to fraudulent healthcare insurance claims.

Wipro’s Data Discovery Platform (DDP) is an integrated platform, which accelerates ‘time-to-insight’ for an enterprise using pre-built industry apps that enable faster decision making, aided by advanced visualizations.

The Fraud Analytics app on DDP helps healthcare insurance providers to identify the characteristics of the fraudulent customers for scrutiny and perform auditing on providers and patients in the short list. The app was developed to derive triggers and characteristics of fraudulent claims in healthcare on a real-time basis and to segment customers for better detection of fraud. It serves as quick reference for healthcare insurance firms to keep a tab on those segments which are most fraudulent along with providing valuable pointers regarding the providers, attendants under whom these patients are admitted/treated, the types of impairments and diagnostic procedures employed.

Key Benefits

  • Provides the ability to check claims from high risk customers thoroughly (more manual interventions) whereas quickly process the low risk customers.
  • Identify the characteristics of the fraudulent customers for scrutiny and perform auditing on providers and patients in the short lists.
  • Helps join the dots with respect to providers, territories, claim amount, diagnostic procedures, attendant specialty, impairments for a comprehensive view of all related aspects to detect and predict fraud.
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