Third-Party Administrators (TPA) have continued to play a very important role in processing health insurance claims. It has become much easier for policyholders now to avail Mediclaim benefits. In fact, the pandemic pushed Insurtech funding to an all-time high. Moreover, the pandemic has prompted many insurers to accentuate their digital transformation efforts and seek support from TPAs that can help accelerate Mediclaims. In an interaction with Express Computer, Himanshu Rastogi, Chief Technology Officer at Medi Assist, outlines how the company has relentlessly innovated to transform claims processing and member experience through superior technology and a well-trained and efficient workforce.
As one of the leading TPAs in the country, how have you transformed your services with the help of enterprise technologies like cloud, data analytics, AI/ML, etc.?
From advanced data analysis and machine learning to automation, the InsurTech space is leveraging disruptive technologies that are transforming the way our industry delivers services and designs products – and Medi Assist is leading the way.
At Medi Assist, all our processes are data-driven and backed by technology. At every step of administering benefits to our policyholders, we use various technologies for better end-user experience. We deploy AI-based technologies to forecast the number of admissions, discharge of patients etc., at any given day or point in time. We use AI and ML combinations to read the financial summary around a patient’s admission. This is a combination of native OCR and extended by NLP in the medical domain. We have multiple models that work in tandem with the above to ascertain and predict fraud, abuse and waste around the bills submitted. We enable portfolio analysis for our customers that lets them understand their premium spend, usage and other Operation KPIs to enable better decision making for them.
What are some of the technology initiatives undertaken specifically over the past two years that helped Medi Assist navigate through the unprecedented times?
The last two years have accelerated the adoption of technology across sectors. Even though technology before the pandemic played an important role in Medi Assist’s operations, there have been several accelerated efforts to not only amplify our operations but also aid the entire insurance ecosystem to function better. We help members/policyholders anticipate out of pocket expenses with Out-of-pocket expense Navigator.
Our Claims are automated via MAtrix, an AI/ML-enabled platform. Insurance companies use our home built tech stack/ Platform-as-a-service and our Network as a service. Our tech platform has made paperless claim submission for hospitals easier. In a nutshell, Medi Assist’s technological capabilities have empowered the entire insurance ecosystem.
Highlight the digital innovations being brought into your services that have enriched the overall customer experience?
Customer Experience sits at the epicenter of all innovation and technology at Medi Assist. From filing claims, fraud detection to reimbursements–our tech stack is based around making the lives of customers easier. Our Fraud detection engine detects and manages frauds while claims are being raised. The Out-of-Pocket Expense Navigator aids policyholders anticipate the amount they would need to pay in case their policy doesn’t cover the health expenses in full. Our technology team has also built an End-to-end digital claim journey, starting with DIY ecard, eCashless facilities on web and app, digital Pre auth, automated claims processed via MAtrix, AI-ML stack for accurate digitization of records, and digital communications
How has AI/ML as a technology been beneficial for the health insurance (mediclaim processing) and TPA sector? Cite examples where Medi Assist has been leveraging AI/ML to automate the processes?
At Medi Assist, the technology team is solving industry problems by building solutions that are a step ahead of others. Matrix, one of our technological products built in-house, has gone on to define automation of claims within the insurance ecosystem. Matrix makes use of AI/ML for efficient digitization and processing of claims.
Any particular technology/technologies that you are betting big on that would transform your services in the near future?
● Robotic process Automation (RPA)- To get better accuracy on human led process so that we can utilize the machines round the clock without altering core systems
● Data Fabric – to consolidate the data and democratize pieces of it
● Chat bot – to answer customer queries in real time