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ease
features
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support

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Description

Claims Signal™ represents a revolutionary open claims quality solution developed by Aon and Athenium Analytics, designed to help insurers detect high-risk claims at an earlier stage. By improving the experience for policyholders, this platform can lead to a significant enhancement in claims indemnity and expenses, estimated between 4% to 6%. In today's fast-paced insurance environment, claims teams face mounting pressure to elevate customer satisfaction, streamline operations, and minimize financial leakage. While routine quality audits can effectively highlight root causes and deviations from optimal practices, the feedback from these audits may not be accessible for weeks or even months post-claim closure. Imagine having the ability to continuously monitor open claims and resolve quality concerns before they negatively impact results. The Claims Signal platform leverages advanced artificial intelligence to scrutinize open claims, identify potential problems, and send immediate alerts, empowering front-line managers to take action before a claim reaches conclusion. With the integration of predictive analytics and timely alerts, insurers can achieve a reduction in claims leakage of up to 4%, ultimately transforming the claims management process. This proactive approach not only enhances operational efficiency but also fosters a culture of continuous improvement within claims teams.

Description

Shift’s Payment Integrity offers an advanced AI-driven solution tailored for health plans, aimed at enhancing the precision and minimizing expenses involved in the claims payment process. This innovative tool operates effectively during both pre-payment and post-payment phases, enabling plan administrators to identify potential issues early on while also recovering overpayments efficiently. Among its notable features are dynamic claims editing with updated rules, AI-supported reviews of medical records, detection of anomalies as well as instances of fraud, waste, and abuse, and integration of external data for a more comprehensive analysis. The system is designed to adapt to changing policies and guidelines, featuring automated policy assessments and an edit logic workbench that allows health plans to experiment with concepts prior to implementation. It also includes clear flags and alerts that inform reviewers about the reasons behind claim flagging, facilitates faster document reviews by emphasizing key sections of records, and employs data mining techniques to uncover emerging trends. Additionally, the platform boasts a cohesive case management interface that streamlines investigative workflows, further enhancing operational efficiency for health plans.

API Access

Has API

API Access

Has API

Screenshots View All

Screenshots View All

Integrations

No details available.

Integrations

No details available.

Pricing Details

No price information available.
Free Trial
Free Version

Pricing Details

No price information available.
Free Trial
Free Version

Deployment

Web-Based
On-Premises
iPhone App
iPad App
Android App
Windows
Mac
Linux
Chromebook

Deployment

Web-Based
On-Premises
iPhone App
iPad App
Android App
Windows
Mac
Linux
Chromebook

Customer Support

Business Hours
Live Rep (24/7)
Online Support

Customer Support

Business Hours
Live Rep (24/7)
Online Support

Types of Training

Training Docs
Webinars
Live Training (Online)
In Person

Types of Training

Training Docs
Webinars
Live Training (Online)
In Person

Vendor Details

Company Name

Athenium Analytics

Country

United States

Website

www.athenium.com/products/claims-signal/

Vendor Details

Company Name

Shift Technology

Founded

2013

Country

France

Website

www.shift-technology.com/products/payment-integrity

Product Features

Insurance Claims Management

CRM
Claims tracking
Customer portal
Document management
EDI data exchange integrations
Electronic claims
Fraud management
Reporting

Product Features

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