-
Industries
- Banking & Financial Services
- Communications
- Consumer Goods
- Education
- Energy & Utilities
- Healthcare
- Information Services
- Insurance
- Life Sciences
- Manufacturing
- Media & Entertainment
- Retail
- Technology
- Transportation & Logistics
- Travel & Hospitality
-
-
COGNIZANT CONSULTING
Helping organizations engage people and uncover insight from data to shape the products, services and experiences they offer
Learn More
-
Services
-
Working to reshape business models, modernize products and enhance customer experiences to drive growth.
Learn More -
Reinventing and managing your most essential business processes with new ways of working.
Learn More -
Simplifying, modernizing and securing the IT infrastructure and applications that are the backbone of your business.
Learn More -
COGNIZANT CONSULTING
Helping organizations engage people and uncover insight from data to shape the products, services and experiences they offer
Learn More
-
- Latest Thinking
- About
INSURANCE
Automation and Expertise Plug the Leaks in Medical Claims Costs
The Challenge
Medical benefits associated with workers’ compensation claims have escalated dramatically, more than tripling since 2003. For one global insurance carrier, excessive or unnecessary treatment associated with these claims resulted in medical claims leakage of a staggering 7% to 9% annually.
The company needed a strategic solution as traditional cost containment strategies, such as bill review, utilization review and nurse case management, were failing to address the leakage. The company partnered with Cognizant to find a solution.
Our Approach
We helped the insurer implement Cognizant OptimaMedWise™, a customizable treatment plan engine for automating claim processing, and combined it with trained clinical services staff to review claims requiring intervention.
This “medical necessity review as a service” capability enables the establishment of injury-specific treatment plans. It also validates clinical activities against those plans, automatically reviews every claim and routes exceptions to trained registered nurses for review.
Routing Reviews to Clinical Experts Optimizes Claims Handling
Integrating medical necessity review into the carrier’s claims process helps facilitate medical care for injured workers, achieve better outcomes and reduce medical costs without increasing claims allocated to loss adjustment expenses.
$50M
in excessive or unnecessary claims identified in six months
$60M
projected annual savings
40%
of claims identified as compliant and processed automatically
VIEW
BPaaS Platforms