Auto-Adjudication Using Claim Scores

Claim Analytics has been working on a number of projects, where the Claim Analytics predictive models are used to auto-adjudicate claims. Here are two examples:

Project 1

AMid-West Workers Compensation insurer is using the claim scores to drive the selection for claims to be auto-adjudicated. Previously no claims were auto-adjudicated, and now they are running at 40%. Learn more

One-Minute Claims Manager/Claims Scoring in Operations

One-Minute Claims Manager/Claims Scoring in Operations – by Barry Senensky and Jonathan Polon. This paper, produced in conjunction with Munich Re, provides an operation view of how to apply claims scoring in the claims management world. Behind the scenes there may be all the best predictive modeling technology, but for the operations manager in a claims department, what does this mean? How can these scores be used? This paper explains the real business value of these highly advanced predictive models that Claim Analytics produces for insurance companies. Learn more

Predictive Modeling for the Insurance Industry Life Insurance Actuary to Claim Scoring Geek

Ten years ago I would never have imagined that I would ever write an article about disability claims. I had been a practicing actuary since 1979 with a career focus virtually exclusively on financial reporting and asset liability management and no real interest or desire in changing. But during a “what have you been up to since we last talked” business lunch with Jonathan Polon, also an actuary and former colleague of mine turned predictive modeler, I was fascinated as Jonathan relayed to me about his exploits into the field of data mining and predictive modeling and the incredible power of these tools for decision making. The career-changing thought then occurred to us that there was a great opportunity to bring this predictive modeling technology to the Life Insurance Industry, and who better to do so than a couple of actuaries with Life Insurance experience. Before that lunch was over, Claim Analytics Inc. was born to provide predictive modeling to the insurance industry. Learn More

DI Apps of Predictive Modeling

Presented by: Jonathan Polon
Predictive Modeling for Workers Compensation 2009 Conference in Chicago IL – 2009
Download Document: PDF, PowerPoint (PPS)

Dynamics Of Disability

Presented by: Barry Senensky & Jonathan Polon Dynamics of Disability Conference – Bonita Springs FL
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Improving Disability Claims Mgmt

Presented by: Barry Senensky & Jonathan Polon Midwest Claim Conference Lake Geneva WI – May 2008
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Dental Insurance Claims: Identification of Atypical Claims Activity

“Our data mining analysis proved to be very effective in patterning dental work and in identifying dentists whose portfolio of claims differed significantly from the norm.”

Barry Senensky & Jonathan Polon
Canadian Institute of Actuaries, Member’s Paper, April 2007

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Sample Scoring Report

Jonathan Polon
Example of a monthly disability scoring report

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Data Mining Goes Mainstream

Steve Lohr, New York Times
“It’s really starting to become mainstream,” says Mr. Davenport, co-author with Jeanne G. Harris of “Competing on Analytics: The New Science of Winning” (Harvard Business School Press, 2007). The entry barrier, he says, “is no longer technology, but whether you have executives who understand this.” Read more…

A Hard Look at Soft Fraud

Bingham et al, Contingencies Magazine, American Academy of Actuaries, March/April ’06

“How is all of this accomplished? It starts with data, lots and lots of data. Valuable data buried in an organization’s claims, case management, and policy and loss control systems…”

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Moneyball: The Art of Winning an Unfair Game

Michael Lewis (ISBN 0-393-05765-8)

“…The collected wisdom of baseball insiders … is subjective and often flawed. By re-evaluating the strategies that produce wins on the field, Billy Beane and the Oakland Athletics, with approximately $55 million in salary, are competitive with the New York Yankees who spent over $205 million annually.” [Wikipedia, "Moneyball"]