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Claims management for a large health insurer in Mexico
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Health insurance is complex, we get it.
The heathcare landscape is evolving causing new challenges for insurers. Qantev understands these complexities, giving insurers the competitive edge they deserve.
Trusted by leading insurers
How we help
We make it easy
With advanced and specialized artificial intelligence technology.
Key challenges
Profit margins are jeopardized: healthcare inflation, increase of utilization, non-scalable operations.
Overwhelming unstructured data: hard to process & clean, causing loss of revenues, limits capacity to act proactively.
Medical claims data complexity: requires specialized approach, causing difficulties to infer patient journeys, lack of insights.
Healthcare market complexity is increasing, consolidation of hospital chains, new & complex types of medical services, etc.
Qantev solution
Reduced claims leakage and improved loss ratios: automated, AI-driven and scalable claims processes.
Clean & enriched data: Specialized OCR, AI-driven data module to clean, enrich and refine your data, for accurate & actionable insights.
AI specialized for health: Layer of intelligence to automate most complex medical claims, medical coding inference, consistency checks, etc.
Insights for best performance: Optimize your provider network thanks to unprecedented leakage insights and providers oversight.
Solution
A platform to help you make insurance better for all
With its modular & scalable AI-driven technology to overcome today and tomorrow's challenges.
Automated claims management
Comprehensive AI-driven solution enabling end-to-end claims management using advanced medical algorithms.
Pre-authorization insights
Medical consistency checks
Automated coverage checks
Fraud, waste & abuse detection
Advanced AI-driven anomaly detection based on historical, local and global industry data aggregation
Automated fraud, waste and abuse detection
Fraud case management
Performance tracking and insights
Specialized OCR & data acquisition
Specialized AI-driven OCR & data acquisition tool designed for medical documents understanding in a health & life insurance context.
Highest accuracy for all languages
Data cleaning and enrichement
Robust medical understanding
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Provider network management
AI-driven strategic insights to manage your network and optimize its performance for leakage reduction.
Provider performance monitoring
Network optimization
Co-pay & geographical panel simulations
A business first approach
Qantev defines and quantifies a business case with every insurer prior to any engagement, insuring the platform generates clear ROI and cost savings.
3-6x
ROI within first 12 months
10%
Reduction in total claims costs
25%
Increase in customer satisfaction
30%
Increase in teams efficiency
We empower your key stakeholders
By harnessing the power of AI, insurance companies can revolutionize their claims management processes, delivering tangible benefits to key personas across the organization.
Special investigation unit teams
Advanced analytics for fraud pattern recognition.
Efficient investigation processes with AI-powered insights.
Proactive fraud mitigation strategies.
Chief executive officers & C-suite executives
Operational efficiency and cost optimization.
Competitive edge with innovative AI solutions.
Compliance and risk mitigation through enhanced fraud detection.
Claims leaders
Accelerated claims processing through intelligent automation.
Improved accuracy and consistency in claims adjudication.
Enhanced fraud detection and prevention capabilities.
Innovation teams
Cutting-edge AI technology for competitive advantage.
Opportunities for process optimization and cost savings.
Scalable and adaptable solution for future growth.