For any non-product related queries, please write to info@perfios.com.
For any non-product related queries, please write to info@perfios.com.
On April 30th, Perfios were announced the Indonesia winners of the Zurich Innovation Championship. Our claims analytics solution, Perfios Acclaim, can save insurers almost $4.8m* a year.
On the left, that’s Benny Jioe, Head of Digital Transformation, Zurich Asuransi Indonesia presenting the award to Amitabh Singh, Chief Business Officer, EMEA & APAC Insurance at Perfios.
So what’s the big problem we’re solving?
A staggering 50% of the world's population remains without health insurance coverage. This is an alarming statistic. And it highlights the urgent need for innovative solutions to bridge this gap and ensure that more people have access to essential healthcare services.
The situation is exacerbated in the ASEA region, where governments and insurers collectively lose $26 billion annually to fake and ineligible claims. That’s money being siphoned out of public healthcare investments and funneled into fraudulent healthcare providers and practitioners.
It comes as no surprise that the healthcare inflation rate in Asia is soaring at 10%, putting immense pressure on both insurers and policyholders. With the minimum wages of workers on this continent increasing only by around 8% annually, we see a rapidly approaching event horizon where one adverse health event wipes out the productive capacities and assets of a majority of the working population and its dependents. This rapid increase in healthcare costs is unsustainable and demands efficient and effective solutions to manage claims and reduce unnecessary expenditures.
Manual claims processing is a significant bottleneck in the health insurance industry, severely impacting customer experience. On average, it takes 8 days to reimburse customer claims, with health insurers facing an average backlog of 3.4 days. This inefficiency not only frustrates customers but also increases the operational costs for insurers.
Where do these costs go? Well, they get passed onto policyholders and insurers as higher premiums, cumbersome policy repricing exercises and complicated policy terms and exclusions that alienate new customers and make health insurance coverage sound like a lottery when they need it the most.
Perfios Acclaim is our cutting-edge solution designed to help insurers overcome these challenges and exit the race to the bottom gripping healthcare today. Our advanced OCR technology digitizes claims, including handwritten bills, effortlessly bypassing even the worst doctor’s handwriting.
By categorizing claims into treatments, procedures, and investigations using sophisticated NLP models, we ensure seamless integration with international disease classification systems like ICD, PCS, and SNOMED. This streamlined categorization facilitates faster and more accurate claims processing by turning human language incomprehensible to computers into machine language that can be analyzed in microseconds.
Perfios Acclaim is equipped with an AI-powered fraud pattern recognition engine that identifies various fraudulent activities, including:
1. Upcoding: Billing for more expensive services than those provided.
2. Unbundling: Separately billing for procedures that should be billed together at a reduced cost.
3. Phantom Billing: Charging for services not rendered.
4. Claims Outliers: Identifying claims that deviate significantly from the norm.
5. Suspicious Provider Behaviors: Detecting unusual patterns in provider billing practices.
For a highly regulated industry like insurance, data privacy and protection naturally emerges as a top priority. Acclaim is tailored to keep insurer minds at ease. With a SaaS-based plug-and-play model, Acclaim doesn’t require extensive data orchestration and integration times with your internal systems. This eliminates any points of failure and potential for data breaches.
Our solution processes over 1 million claims annually, delivering impressive results for our clients. On average, Perfios Acclaim saves 3-6% of claims payout expenses, significantly improving the financial health of insurance companies and allowing them to provide better services to their customers.
With Perfios Acclaim, we are not just processing claims; we are redefining the future of health insurance.
At a conservative claims volume of 10,000 claims per month and an average claim amount of USD 2000, a 5% saving in claims payout amounts to $10M rescued from our clients’ operating costs!
