validating claims with advanced analytics
play

Validating Claims with Advanced Analytics John Standish Chief - PowerPoint PPT Presentation

Apr 07, 2024 •47 likes •237 views

Validating Claims with Advanced Analytics John Standish Chief Marketing Officer Are Your Team Members Synchronized? Business Process U/W Compliance Claims Risk Investigate Medical SIU Business Validate FWA Next Pay Steps

  1. Validating Claims with Advanced Analytics John Standish � Chief Marketing Officer �

  3. Are Your Team Members Synchronized?

  4. Business Process U/W Compliance Claims Risk Investigate Medical SIU • Business Validate FWA Next Pay Steps

  5. Rule of 3: 1. State the problem. 2. Discover the possibilities. 3. Execute.

  7. Google Servers, � Douglas County, GA

  9. 447,000 +

  11. Insurance and Risk

  12. How do you validate a claim? Indicators? Risk? Pattern recognition -machine learning! Cognitive computing.

  14. Advanced Analytics in an Insurance Claim Context Business � Data � Federated � Intelligence Management Searches Reactive Proactive Social and � Social Media � Text Analysis � Network � Analysis NLP Analysis Machine � Predictive � Analytics Learning Modeling

  15. “ Modus Operandi “- a particular way or method Claim of doing something, especially one that is characteristic or well-established 100 MOA MOP Analysis Invest. Pay/Decline

  16. What is your data revealing?

  18. W here are you going? How will you get there?

  19. Thank you jstandish@infinilytics.com (760) 809-3553 http://www.linkedin.com/pub/john-standish/9/548/a1b/ @JohnStandish136

Recommend

WIILSUG Conference Milwaukee, WI, June 20, 2018 Advanced Analytics Consulting Services T

WIILSUG Conference Milwaukee, WI, June 20, 2018 Advanced Analytics Consulting Services T

WIILSUG Conference Milwaukee, WI, June 20, 2018 Advanced Analytics Consulting Services T argeting Return-to-Work Intervention by Predicting Prolonged Workers' Compensation Claims Mei Najim, CSPA, Advanced Analytics Consultant and Advisor Mrs.

329 views • 21 slides
Claims Process Reengineering and Predictive Analytics CLRS 2013 Lauren Cavanaugh, FCAS, MAAA

Claims Process Reengineering and Predictive Analytics CLRS 2013 Lauren Cavanaugh, FCAS, MAAA

Claims Process Reengineering and Predictive Analytics CLRS 2013 Lauren Cavanaugh, FCAS, MAAA September 16, 2013 Agenda Overview of Claims Process Reengineering Claims Leakage Defined Implementation of Changes to Claims Process

603 views • 28 slides
So you think you can dance? Some concrete suggestions and cautions in evaluating/validating

So you think you can dance? Some concrete suggestions and cautions in evaluating/validating

So you think you can dance? Some concrete suggestions and cautions in evaluating/validating claims of college readiness Thanos Patelis Center for Assessment Presentation at the National Conference on Student Assessment San Diego, CA June 23, 2015

305 views • 26 slides
Validating logistic regression results Anurag Gupta People Analytics Practitioner DataCamp

Validating logistic regression results Anurag Gupta People Analytics Practitioner DataCamp

DataCamp Human Resources Analytics: Predicting Employee Churn in R HUMAN RESOURCES ANALYTICS : PREDICTING EMPLOYEE CHURN IN R Validating logistic regression results Anurag Gupta People Analytics Practitioner DataCamp Human Resources

502 views • 33 slides
Data Science Issues & Collaboration Eugene Wen, MD. DrPH. VP Group Advanced Analytics

Data Science Issues & Collaboration Eugene Wen, MD. DrPH. VP Group Advanced Analytics

Data Science Issues & Collaboration Eugene Wen, MD. DrPH. VP Group Advanced Analytics Manulife Canada Data Science Workshop, Toronto, April 30, 2018 Advanced Analytics in Manulife/John Hancock Cindy Forbes, EVP, Chief Analytics

194 views • 5 slides
Developing and Validating Advanced Divertor Solutions for Next-Step Fusion Devices DiMES DIII-D

Developing and Validating Advanced Divertor Solutions for Next-Step Fusion Devices DiMES DIII-D

Developing and Validating Advanced Divertor Solutions for Next-Step Fusion Devices DiMES DIII-D Experiments By H.Y. Guo and BPMIC Team Edge Theory Presented to the Boundary DIII-D IAEA-TM on Divertor Boundary/PMI Concepts Initiative

551 views • 20 slides
Using Predictive Analytics to Detect F Fraudulent Claims d l Cl i May 17, 2011 Roosevelt C.

Using Predictive Analytics to Detect F Fraudulent Claims d l Cl i May 17, 2011 Roosevelt C.

Using Predictive Analytics to Detect F Fraudulent Claims d l Cl i May 17, 2011 Roosevelt C. Mosley, Jr., FCAS, MAAA CAS Spring Meeting Palm Beach, FL Experience the Pinnacle Difference! Predictive Analysis for Fraud Claim fraud is

546 views • 37 slides
Developing and Validating An Evidence Based Framework for Grading and Assessment of Predictive

Developing and Validating An Evidence Based Framework for Grading and Assessment of Predictive

Developing and Validating An Evidence Based Framework for Grading and Assessment of Predictive Tools for Clinical Decision Support Mohamed Khalifa, MD, MSc, MRCSEd, CPHIMS AIHI Australian Institute of Health Innovation Health Data Analytics

258 views • 14 slides
ANALYTICS EDUCATION AND THE EVOLVING WORKFORCE Dr. Aric LaBarr Institute for Advanced Analytics

ANALYTICS EDUCATION AND THE EVOLVING WORKFORCE Dr. Aric LaBarr Institute for Advanced Analytics

Analytics Education and the Evolving Workforce 17 Nov 2013 Outside Pressure to have Data ANALYTICS EDUCATION AND THE EVOLVING WORKFORCE Dr. Aric LaBarr Institute for Advanced Analytics North Carolina State University Data Flood Data Driven

642 views • 21 slides
Analysis of Bypassing Detection by Microsoft Advanced Threat Analytics Edgar Bohte and Nick

Analysis of Bypassing Detection by Microsoft Advanced Threat Analytics Edgar Bohte and Nick

Analysis of Bypassing Detection by Microsoft Advanced Threat Analytics Edgar Bohte and Nick Offerman Research Project 2 #72 Introduction - Advanced Threat Analytics (ATA) Microsoft Active Directory (AD) On-premise Post-Infiltration

439 views • 25 slides
Validating a technique for post-hoc estimation of a listener's focus in music structure analysis

Validating a technique for post-hoc estimation of a listener's focus in music structure analysis

Validating a technique for post-hoc estimation of a listener's focus in music structure analysis Jordan B. L. Smith National Institute of Advanced Industrial Science and Technology (AIST), Japan Elaine Chew Queen Mary University of London

442 views • 30 slides
Advanced Analytics in Business [D0S07a] Big Data Platforms & Technologies [D0S06a] Data

Advanced Analytics in Business [D0S07a] Big Data Platforms & Technologies [D0S06a] Data

Advanced Analytics in Business [D0S07a] Big Data Platforms & Technologies [D0S06a] Data Science Tools Overview In-memory analytics Python and R More on visualization The road to big data Notebooks and development environments A word on

1.38k views • 85 slides
Advanced Analytics in Business [D0S07a] Big Data Platforms & Technologies [D0S06a] Data

Advanced Analytics in Business [D0S07a] Big Data Platforms & Technologies [D0S06a] Data

Advanced Analytics in Business [D0S07a] Big Data Platforms & Technologies [D0S06a] Data Science Tools Overview In-memory analytics Python and R More on visualization The road to big data Notebooks and development environments A word on

1.23k views • 100 slides
Claims & Underwriting Claims Accuracy: Claims Accuracy: Striking a balance between accurate

Claims & Underwriting Claims Accuracy: Claims Accuracy: Striking a balance between accurate

Claims & Underwriting Claims Accuracy: Claims Accuracy: Striking a balance between accurate claims decisions and administrative cost David Dysart, Senior Associate LTC Claims, NY Life Angie Forsell, VP Clinical Services, LTCG Angie

645 views • 39 slides
APAC 101 1 Overview OFFICE OF HEALTH ANALYTICS Health Policy and Analytics Division 2 What is

APAC 101 1 Overview OFFICE OF HEALTH ANALYTICS Health Policy and Analytics Division 2 What is

APAC 101 1 Overview OFFICE OF HEALTH ANALYTICS Health Policy and Analytics Division 2 What is APAC? The Oregon All Payer All Claims Database (APAC) is a large database that houses administrative health care data for Oregons insured

417 views • 26 slides
Workshop H Advanced Practices Lifestyle Medicine in the Workplace to Reduce Healthcare Claims

Workshop H Advanced Practices Lifestyle Medicine in the Workplace to Reduce Healthcare Claims

Workshop H Advanced Practices Lifestyle Medicine in the Workplace to Reduce Healthcare Claims & Costs 11:15 a.m. to 12:30 p.m. Biographical Information Tom Kostohryz, Founder, Live Healthy Appalachia 145 Columbus Rd., Ste. 201, Athens,

1.02k views • 44 slides
Claims 1. Common law 2. Ex gratia 3. Contractual 1. Common law claims 2. Ex gratia claims

Claims 1. Common law 2. Ex gratia 3. Contractual 1. Common law claims 2. Ex gratia claims

Contractors claims may be of three kinds: Claims 1. Common law 2. Ex gratia 3. Contractual 1. Common law claims 2. Ex gratia claims No legal base, but are claims which the Contractor These arise from causes which are outside

416 views • 3 slides
Advanced Analytics in Business [D0S07a] Big Data Platforms & Technologies [D0S06a]

Advanced Analytics in Business [D0S07a] Big Data Platforms & Technologies [D0S06a]

Advanced Analytics in Business [D0S07a] Big Data Platforms & Technologies [D0S06a] Preprocessing Overview Selection Cleaning Transformation Feature selection Feature extraction Sampling 2 The analytics process 3 The data set

1.19k views • 43 slides
Security Data Science Joshua Neil Security Analytics Leader Advanced Security Center EY

Security Data Science Joshua Neil Security Analytics Leader Advanced Security Center EY

Security Data Science Joshua Neil Security Analytics Leader Advanced Security Center EY Powered by Agenda A Background, LANL and the EY/LANL Alliance Traditional Security and Operational Security Data B Science Advanced Analytics:

558 views • 24 slides
Advanced Analytics & SEO Workshop Nov 16, 2017 Georgia Institute of Technology About

Advanced Analytics & SEO Workshop Nov 16, 2017 Georgia Institute of Technology About

Advanced Analytics & SEO Workshop Nov 16, 2017 Georgia Institute of Technology About Cheyenne Throckmorton Georgia Tech Graduate - B.S. Comp Sci ( Psy | Cog Sci ) 15+ Years Pharma Industry Leadership Coach Owner of Massive Reach | 2015

798 views • 68 slides
Notice of Claims in Claims-Made Insurance Policies Identifying Claims; Evaluating Whether and

Notice of Claims in Claims-Made Insurance Policies Identifying Claims; Evaluating Whether and

Presenting a live 90-minute webinar with interactive Q&A Notice of Claims in Claims-Made Insurance Policies Identifying Claims; Evaluating Whether and When to Report WEDNES DAY, FEBRUARY 22, 2012 1pm East ern | 12pm Cent ral |

652 views • 36 slides
Advanced Analytics in Business [D0S07a] Big Data Platforms & Technologies [D0S06a] Hadoop and

Advanced Analytics in Business [D0S07a] Big Data Platforms & Technologies [D0S06a] Hadoop and

Advanced Analytics in Business [D0S07a] Big Data Platforms & Technologies [D0S06a] Hadoop and MapReduce Spark Streaming Analytics Overview Big data Hadoop MapReduce Spark SparkSQL MLlib Streaming analytics and other trends 2

1.92k views • 158 slides
Advanced Analytics in Business [D0S07a] Big Data Platforms & Technologies [D0S06a] Hadoop and

Advanced Analytics in Business [D0S07a] Big Data Platforms & Technologies [D0S06a] Hadoop and

Advanced Analytics in Business [D0S07a] Big Data Platforms & Technologies [D0S06a] Hadoop and MapReduce Spark Streaming Analytics Overview Big data Hadoop MapReduce Spark SparkSQL MLlib Streaming analytics and other trends 2 The

2.05k views • 157 slides
Successful implementation of Big Data and Advanced analytics in O&G Oslo, February 10 th 2015

Successful implementation of Big Data and Advanced analytics in O&G Oslo, February 10 th 2015

Successful implementation of Big Data and Advanced analytics in O&G Oslo, February 10 th 2015 DRAFT This information is confidential and was prepared by Bain & Company solely for the use of our client; it is not to be relied on by any 3rd

276 views • 23 slides

More recommend