Predictive Modeling

Introduction

Predictive Modeling is the process by which a model is created to best predict the outcome or probability of an outcome. Predictive models are developed using historical data or purposely collected data. We offer predictive modeling service for Health Insurers, specifically in the areas of ‘Fraud Detection’ and ‘Customer Persistency’.

Our team has experience in building models using traditional methods and new generation data mining algorithms.

Fraud Detection In Health Insurance

Fraudulent claims in medical insurance are a serious problem, leading to huge losses for insurers and higher premiums for people. Traditional fraud detection systems use business rules which are applied to each claim recorded. Although useful, traditional methods may fail to discover abnormal pattern and large number of cases are investigated to detect fraudulent claims.

Our solution for fraud detection is based on predictive modeling (traditional and new generation) and social network analysis. Features of our solution:

  • Reduced cost of investigation
  • Increase in the number of frauds detected
  • Development of an Automated Time Saving mechanism for fraud detection
  • Exhaustive Pattern Recognition using modeling

Persistency Modeling

Non renewal of policies has been an issue of concern for Health Insurance companies in India. The reasons for lapses vary from customer tendencies to the overall economic conditions in the country. With loss of revenue running into huge sums of money, the need for predicting policy lapses and then taking preventive measures to minimize such cases is quite serious. To identify the indicators of lapse and predict the probable policy lapses, analytics provides solutions through advanced modeling techniques. Our solution to this problem is based on high level business understanding coupled with advanced analytics methods. Data from various sources (policy holder’s information, policy details, agent details, economy indicators etc) are integrated to build robust prediction model.

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