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Claims management for a large health insurer in Mexico
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Network management
Improve your network's performance through automated AI-driven insights, pricing gap detection, strategy recommendation, simulations, and more.
30%
Increase in network manager efficiency.
8%
Claims cost reduction.
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Features
Overcome leakage and unlock opportunities
Optimize your provider network and save up to 15% costs thanks to unprecedented leakage insights using the Qantev platform.
Contract management
Price list & discounts negotiation, contract targeting, contracted prices mismatch detection & insights.
Product optimization
Limit, copay, exceptions recommendations & impact simulation, product repricing alert.
Anomaly detection
Targeted audits recommendation, early trends detection, fraudulent provider detection and insights.
Network optimization
Targeted performing providers promotion, network tiering/retiering recommendations.
Provider performance monitoring
Comprehensive 360 view of all providers, computing 60+ highly specialized cost & quality KPIs in real time.
Data enrichement & foundation
Network data ingestion from internal and external sources, applying cleaning & refining algorithms.
Simulation tools
Real-time impact estimation of revenue & member choices based on changes: tiers, discounts, pricing, deductible, copay, limits, etc.
How it works
Optimize your provider network with specialized AI
Smarter data
Ai to improve data quality, enriching it with internal and external network data localized to each markets.
Smarter insights
AI insights to enhance your decision-making towards identified gaps and inefficiencies, run simulations, monitor member behaviors, etc.
Smarter operations
Ai to help streamline your network management workflows, increase efficiency, customer satisfaction and reduce costs.
Learn, fine-tune, repeat
Integration with third party databases and feedback loops to improve accuracy and intelligne of the platform.
Get 3-6x ROI within 24 months
30% efficiency increase
Improved network performance increase observed in first 24 months.
Reduced claims leakage
Reduction in human errors, higher efficiency and FWA patterns detection.
Higher customer satisfaction
Faster turn around time and reduction in errors making your customers more happy.
Higher provider compliance
Higher number of providers adhering to regulatory and contractual standards.
Rapid deployment
Average of 4 to 6 months deployment of the platform within insurers ecosystems.
Easy integrations
Modular and API-driven architecture to fit within your complex ecosystem.