By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
SmartData CollectiveSmartData Collective
  • Analytics
    AnalyticsShow More
    analyst,women,looking,at,kpi,data,on,computer,screen
    What to Know Before Recruiting an Analyst to Handle Company Data
    6 Min Read
    AI analytics
    AI-Based Analytics Are Changing the Future of Credit Cards
    6 Min Read
    data overload showing data analytics
    How Does Next-Gen SIEM Prevent Data Overload For Security Analysts?
    8 Min Read
    hire a marketing agency with a background in data analytics
    5 Reasons to Hire a Marketing Agency that Knows Data Analytics
    7 Min Read
    predictive analytics for amazon pricing
    Using Predictive Analytics to Get the Best Deals on Amazon
    8 Min Read
  • Big Data
  • BI
  • Exclusive
  • IT
  • Marketing
  • Software
Search
© 2008-23 SmartData Collective. All Rights Reserved.
Reading: DIALOG Improving Customer Experience in Health Insurance
Share
Notification Show More
Aa
SmartData CollectiveSmartData Collective
Aa
Search
  • About
  • Help
  • Privacy
Follow US
© 2008-23 SmartData Collective. All Rights Reserved.
SmartData Collective > Business Intelligence > CRM > DIALOG Improving Customer Experience in Health Insurance
Business IntelligenceCRMData MiningPredictive Analytics

DIALOG Improving Customer Experience in Health Insurance

JamesTaylor
Last updated: 2009/02/05 at 11:25 PM
JamesTaylor
6 Min Read
SHARE

(Guest post by James Taylor of Decision Management Solutions)

Gerhard Hausmann presented on Barmenia and their use of business rules to improve customer experience. Barmenia is a private health / life insurance company in Germany with more than 2M contracts and 1.5Bn Euros in premiums. Been in business since 1904 and still have contracts that date back to the last century. In Germany there is a mix of public and private health insurance – 70M people have public insurance and 8.5M are privately insured with another 20M having some additional private health insurance. Barmenia, like many companies, is facing challenges from an ageing population. For health insurance this is a particular challenge as older people are more expensive.

Barmenia is graded by a German quality organization and consistently gets A+ (6th time in a row) in part thanks to the system supporting 48 hour claims processing that is accurate and competent. Barmenia has been adding decision support in claims processing starting 2003 with a database of reimbursement information and moving to using ILOG rules in 2007 for auditing complex dental invoices, naturopath invoices and case assignment. They took a decision-sup…


Gerhard Hausmann presented on Barmenia and their use of business rules to improve customer experience. Barmenia is a private health / life insurance company in Germany with more than 2M contracts and 1.5Bn Euros in premiums. Been in business since 1904 and still have contracts that date back to the last century. In Germany there is a mix of public and private health insurance – 70M people have public insurance and 8.5M are privately insured with another 20M having some additional private health insurance. Barmenia, like many companies, is facing challenges from an ageing population. For health insurance this is a particular challenge as older people are more expensive.

More Read

data perspective

Tackling Bias in AI Translation: A Data Perspective

How AI is Boosting the Customer Support Game
AI-Based Analytics Are Changing the Future of Credit Cards
Enterprises Are Leveraging the Benefits of AI-Driven ERPs
AI In Marketing: Is It Worth the Hype?

Barmenia is graded by a German quality organization and consistently gets A+ (6th time in a row) in part thanks to the system supporting 48 hour claims processing that is accurate and competent. Barmenia has been adding decision support in claims processing starting 2003 with a database of reimbursement information and moving to using ILOG rules in 2007 for auditing complex dental invoices, naturopath invoices and case assignment. They took a decision-support approach because they feel they have good experts. They decided on a custom rules approach to get short logic release cycles and to avoid the need for the large integration projects that come with out of the box implementations.

They use a few thousand rules in some decision tables, a few hundred regular rules to and many patterns to manage the rules for dental invoices – pricing, eligibility, allocation etc. They scan invoices and route them through an ESB. Simple ones are verified and decisions are automated using ILOG. More complex ones are routed to the case management system (again using ILOG rules-based assignment) with embedded instructions (generated from more ILOG rules). These are displayed to experts using an environment that combines the invoices, master data and decision support. Because they are still using a mainframe application they use a mixed interface that displays a mainframe screen with claims information related to several invoices, a display of an invoice and a decision support screen.

Managing complexity in rules is a focus area for them. Rules become complex when multiple objects with multiple properties must be considered. An example rule with 9 conditions requires 500 test cases. The handling of exceptional cases is a particular indicator of complexity. To manage this they use ruleflows to put default rules (simpler, cover lots of cases) first then create a series of exception steps with each exception step handling a few rules for a group of exceptions. This prevents the complexity from overwhelming rule editing. They use the Business Action Language to make the rules accessible to business users and they put business experts into the QA process, having them create and run tests for their rules. Regression tests are handled by IT with experts conducting random tests on the new version.

Benefts:

  • BRMS uses lots of facts, more than a person would, and so the system decides slightly better than the experts used to.
  • Supports those who handle cases so that less experienced handlers (trainees for instance) helping them close out potentially complex claims. More claims can be hanlded by the usual teams.
  • Increased agility – they were able to add the rules for detecting simple cases and QA the rules in just 4 weeks.
  • Resources are allocated more efficiently with claims being  routed to case handlers or to experts appropriately. Fewer are routed to experts (less than 40%), improving response time.

They plan to extend the system to handle underwriting as well as invoices from more kinds of providers.


Link to original post

JamesTaylor February 5, 2009
Share This Article
Facebook Twitter Pinterest LinkedIn
Share

Follow us on Facebook

Latest News

data breaches
How Hospital Security Breaches Devastate Local Communities
Policy and Governance
analyst,women,looking,at,kpi,data,on,computer,screen
What to Know Before Recruiting an Analyst to Handle Company Data
Analytics
data perspective
Tackling Bias in AI Translation: A Data Perspective
Big Data
Data Ethics: Safeguarding Privacy and Ensuring Responsible Data Practices
Data Ethics: Safeguarding Privacy and Ensuring Responsible Data Practices
Best Practices Big Data Data Collection Data Management Privacy

Stay Connected

1.2k Followers Like
33.7k Followers Follow
222 Followers Pin

You Might also Like

data perspective
Big Data

Tackling Bias in AI Translation: A Data Perspective

9 Min Read
How AI is Boosting the Customer Support Game
Artificial Intelligence

How AI is Boosting the Customer Support Game

6 Min Read
AI analytics
AnalyticsArtificial IntelligenceExclusive

AI-Based Analytics Are Changing the Future of Credit Cards

6 Min Read
ai-driven ERP software
Artificial Intelligence

Enterprises Are Leveraging the Benefits of AI-Driven ERPs

8 Min Read

SmartData Collective is one of the largest & trusted community covering technical content about Big Data, BI, Cloud, Analytics, Artificial Intelligence, IoT & more.

data-driven web design
5 Great Tips for Using Data Analytics for Website UX
Big Data
AI and chatbots
Chatbots and SEO: How Can Chatbots Improve Your SEO Ranking?
Artificial Intelligence Chatbots Exclusive

Quick Link

  • About
  • Contact
  • Privacy
Follow US
© 2008-23 SmartData Collective. All Rights Reserved.
Go to mobile version
Welcome Back!

Sign in to your account

Lost your password?