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Medscheme Transforms Claims Management Efficiency using FICO Decision Technology

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5 years ago

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Reading Time: 3 minutes

 

  • Medscheme has created a modern decision platform for its Medical Aid Administration business, which reviews some 400,000 claim lines per day, based on FICO® Blaze Advisor™ decision rules management system
  • Medscheme won the 2018 FICO® Decisions Award for Decision Management Innovation
  • Medscheme is one of South Africa’s largest providers of administrative and health risk management solutions for the healthcare sector

Medscheme, one of South Africa’s largest providers of administrative and health risk management solutions for the healthcare sector, has created a modern decision platform for its Medical Aid Administration business, which reviews some 400,000 claim lines per day. The innovative solution, powered by FICO® Blaze Advisor™ decision rules management system, reduced claim interventions by 15 percent in a six-month period, and has dramatically reduced the time needed to change business rules and strategies.

For its achievements, Medscheme won a 2018 FICO® Decisions Award for Decision Management Innovation.

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“Our vision is to create a world with sustainable healthcare, and at the heart of our business is processing medical claims of members and healthcare providers,” said Denise Sleem, general manager and project lead at Medscheme. “By modernizing our claims management capabilities, we have become more agile, more efficient and more effective, which means members and healthcare providers get faster answers on claims.”

“Our focus is on efficient and effective administration services that are optimized and responsive to varying medical scheme needs at any given time,” said Andrew Wright, executive manager for Shared and Support Services at Medscheme. “We thus need to constantly challenge the way we work and where we wish to invest in enhancing our broader healthcare administration capabilities that will ensure they are relevant into the future.

“Furthermore, Medscheme requires flexibility in its claims capability, which is especially important today as we bring on board new clients with thousands of members with their own set of rules. Our claims engine needs to easily accommodate the variety of client scheme needs and integrate seamlessly with our core administration system, with very little room for errors or delays.”

Transforming a Legacy System
In rebuilding their claims management system, Medscheme had clear requirements. They needed modern, scalable technology that could support their needs into the future, integrate well with the rest of their IT infrastructure, and meet stringent SLAs for claim review times. The new system had to make rules and policies visible, be accessible to business and technical teams, and be much easier and quicker to change.

“The business rules that informed our decisions in our claims processing were mostly locked up in code, data and people’s minds,” explained Sleem. “We had to discover them, document them and move them swiftly into the new system. FICO has been a terrific partner for us in this effort.”

Medscheme created a framework using cloud-native technologies including Kubernetes, Docker and Spring Boot, within which the FICO Blaze Advisor decision rules system runs. “This environment is extremely scalable, and can be used either on-premise or with any of the big three cloud provider spaces, and can be run in a hybrid model as well,” said Drikus Britz, lead solutions architect at Medscheme. “The solution allows for zero downtime deployments within a day should the need arise. We are running in an active-active mode across multiple data centers, allowing for almost zero downtime during disaster recovery situations for real-time claims.”

Due to the high volume and complex rules associated with medical claims, Medscheme needed to think carefully about performance. “We use Hazelcast to cache information related to our clinical data that does not have a high frequency of change,” Britz said. “This allowed for the decision engine itself to remain stateless, while having frequently used information a lot ‘closer’ to the engines, which drastically improved speed. To further improve performance, we enhanced the components that serialize and de-serialize the incoming and outgoing requests to and from Blaze Advisor. We also have moved to a semi de-normalized object model inside Blaze Advisor, which gives us the most efficient way of rule writing and execution at runtime.”

Clear Benefits to Modernization
Medscheme has recorded a number of benefits of their new system:

  • Fast processing of an average of 400,000 claim lines per day
  • Easy to respond to a query about a decision, due to fully documented business rules
  • Claim interventions reduced by 15 percent over a six-month period
  • 99.9% uptime — a stable product on a stable platform with the ability to do online deployments
  • Ability to respond quickly to market changes and varied client requirements
  • Multiple resources able to work on multiple changes to the decision services code at a time
  • A consolidated rules management repository enables flexibility and traceability of decisions
  • More agile rule capabilities for changing benefit designs, allowing for increased volume and complexity

“We are impressed by the technical ingenuity of the Medscheme team,” said Nikhil Behl, vice president of marketing at FICO. “This is a fantastic solution to a common problem — modernizing a legacy system to improve efficiency and customer satisfaction.”

FICO® Blaze Advisor™ decision rules management system gives businesses maximum control over high-volume operational decisions. Blaze Advisor provides companies with a scalable solution that delivers unprecedented agility and actionability for smarter business decisions. FICO Blaze Advisor is part of the groundbreaking FICO® Decision Management Suite for building and deploying decision management applications.

 

Photo source: SOURCE FICO

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MapMetrics expands to peaq from Solana following addition of Solana compatibility to peaq’s Multi-Chain Machine IDs

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5 days ago

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November 23, 2023

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peaq, the blockchain for real-world applications, announces the expansion of its ecosystem and product offering. MapMetrics, a Web3 drive-to-earn navigation app, will leverage peaq as part of its decentralized physical infrastructure network (DePIN) powering a Google Maps-style service. The development comes as peaq adds Solana compatibility to its Multi-Chain Machine IDs.

A Solana-originating project, MapMetrics will leverage the now Solana-compatible peaq IDs to build functions of the MapMetrics DePIN on peaq. These will include assigning peaq IDs to the navigator devices on its DePIN, using these IDs to authenticate the data collected by these devices, and a community voting mechanism.

Free navigation apps have become trusty companions for countless people around the world, with Google Maps alone boasting over a billion users. But despite a lack of an upfront cost, they come with a price of their own. When something is free, you are the product; when navigation is free, your personal data is being monetized. From leveraging the user’s position data for valuable insights on specific locations to serving them targeted location-based ads, the companies behind such apps profit from our sensitive data, sometimes without giving much thought to its privacy and protection. And in the case of massive companies like Google, they combine this data with the data sourced from all other Google-related data points to create digital models of ourselves, able to predict our behavior than ourselves.

MapMetrics is changing the equation by putting navigation on Web3 rails. It uses location trackers that enable users to share their anonymized data with the network, earning cryptocurrency and NFTs as rewards. While featuring its own ad engine, it makes sure that no private user data is exposed to the advertisers and shares the ad revenue with the community. It boasts 3,500 devices in the network and 5,000 users across 73 countries.

As part of its integration with peaq, MapMetrics will use peaq’s Multi-Chain IDs to enable devices to connect with the peaq network. It will build and deploy some of the core functions powering its navigation DePIN on peaq, using peaq IDs to authenticate and sign the anonymized data that the devices collect. It will also tap peaq to build a community voting pallet — a building block that other projects will be able to use as well — which will enable the community to contribute to its Google Maps-style navigation service by adding the locations of speed cameras and other objects and validating it with votes.

This comes as peaq expands the compatibility of its peaq IDs to include Solana. Enabling this is an address map running as part of the peaq storage pallet, pallets being modules for building blockchains in the framework that peaq runs on. This map works like an address book, linking addresses of different standards used on various networks and thus enabling cross-chain communication and information exchanges.

For example, with this integration, a solar panel with an ID on Solana will be able to connect to an energy marketplace on peaq. The previous updates made peaq IDs compatible with Binance’s BNB Chain, Ethereum Virtual Machine, and Cosmos. peaq’s steps toward its Multi-Chain vision have already eased the transition for projects coming from Algorand and Polygon, and will now unlock new opportunities for MapMetrics and other projects in the Solana ecosystem.

The peaq ID compatibility expansion enables teams originating on Solana to expand and leverage peaq’s DePIN functions without friction or fragmentation. With peaq Multi-Chain IDs, Solana-originated projects can easily tap peaq for some of their crucial functions.

“With its DePIN-focused functions and economics, peaq is the perfect home for DePINs,” says Brent van der Heiden, CEO of MapMetrics. “We are excited to be joining this bustling ecosystem, and the newfound compatibility between peaq IDs and Solana addresses is making this process significantly more convenient.”

“We believe in an open, Multi-Chain Web3 with seamless communication and value exchange between a plethora of protocols,” says Till Wendler, co-founder of peaq. “By making peaq IDs compatible with Solana, we take another step toward bringing this vision to life — and it’s invigorating to see excellent projects such as MapMetrics use this technology to solve real business problems with the DePIN model.”

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Spool hones in on bringing institutions into DeFi by launching its expansive V2 upgrade

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7 days ago

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November 22, 2023

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Spool DAO, or Spool, the platform allowing institutions and users to build customizable risk-managed DeFi products, launches its V2 upgrade. Spool’s new platform expands its original DeFi infrastructure and tools, with heightened decentralized access and new capabilities. Institutions of all sizes can now leverage its slate of new features and interface updates to build, manage, and explore DeFi products with unparalleled flexibility, risk reduction, and security.

Despite crypto’s whirlwind year, DeFi’s blue-chip protocols managed to largely withstand the industry-wide chaos. But that doesn’t mean the DeFi landscape hasn’t changed at all. Looming regulatory steps, such as the new bipartisan bill entering the U.S. Senate, aim to monitor DeFi apps similarly to banks, setting the stage to accommodate increasing interest from legacy financial institutions. Banks and institutions clearly see potential in crypto and DeFi’s financial possibilities, but they lack the proper tools to enter it easily, compliantly, and on their terms.

To meet this institutional need, Spool now provides a completely rebuilt platform for risk-managed and automated DeFi yield. Created from the ground up to be faster, more efficient, more composable, and easier to use than its predecessor, V2 represents a leap for Spool and institutions expanding their DeFi presence. The upgrade expands upon Spool’s core offering and introduces several key features to maximize the effectiveness of institutional DeFi investment. These features and enhancements include:

    • Multi-Asset Smart Vaults: Institutions creating Smart Vaults can now build them to contain a range of yield strategies using multiple assets. Multi-asset Smart Vaults enhance functionality in addition to Spool’s classic auto-swapping and auto-rebalancing capabilities. Investors can simply create or pick an existing Smart Vault that matches their investment preferences, and send the assets they have available. The assets are then automatically swapped and implemented in audited and battle-tested smart contracts to attain the best yields possible while allowing funds to be withdrawn at any time.
    • Smart Vault Guards: Institutions building Smart Vaults can now dictate which users can deposit or withdraw from the Vault based on specific criteria, mirroring traditional investment funds. This helps institutions tailor DeFi offerings not only to regulatory compliance but to their specific client needs as well. Institutions can create KYC and AML-compliant Smart Vaults, for example, and only allow access to vetted investors through whitelisted wallets. Other parameters include NFT or Token Gating (where a user must hold a specific NFT or token amount to access the vault), and Time Locks.
    • Actions: Spool builders can now implement customizable actions tied to user activities such as entering or exiting a Smart Vault that is configured during its creation. Actions help support institutions by creating a framework that feels familiar to traditional finance and includes features such as deposit or withdrawal fees, deposit insurance fees, and automated asset swaps that help streamline the once-manual process for yield farming.
    • Liquid Staking Derivatives (LSDs) Support: LSDs are tokens issued in return for staking cryptocurrency through a staking provider. This comes in handy for networks such as Ethereum, where validators must hold a minimum of 32 ETH to access staking and validator privileges. LSDs also allow users to withdraw staked ETH, which validators cannot do. As strategies using LSDs become more popular and prevalent, adding support in V2 enables greater convenience.
    • Advanced Automation: One of DeFi’s major obstacles lies in manual asset management within yield farms. V2 improves upon Spool’s original automation features while maintaining decentralization and self-custody. Once assets are within a Smart Vault portfolio, V2 automatically rebalances them between various strategies configured in the Vault. Spool also now offers automated collateral conversion, meaning clients investing in a Smart Vault can utilize any underlying asset they have available. Spool automatically converts the asset before investing, granting increased ease and choice.
    • Deposit NFTs (dNFTs): D-NFTs provide users with an immutable NFT receipt of their Smart Vault deposits, enabling the withdrawal of funds. ERC-20 Smart Vault Tokens (SVTs) are created by burning D-NFTs and act as yield-bearing stablecoins, which can be easily transferred or traded on a secondary market, creating a new liquid financial instrument.

Check out Spool’s video here: https://drive.google.com/file/d/150B6sSdX9gMAjdig-5675nLfftciWidJ/view

More detailed video with features overview can be found here: https://drive.google.com/file/d/1uIr_AJ_iHKErkHR5lFaUWk39A4-NUtEo/view?usp=drive_link

Among these new features, Spool V2’s completely redesigned interface allows institutions and asset managers to have a birds-eye view of their Smart Vault portfolio. The platform champions accessibility while providing the comprehensive tools and oversight that institutions require. This includes tools for easily white-labeling Smart Vaults for client access with their own branding and unique insights into Smart Vault performance based on customizable KPIs.

By enabling the codeless creation of financial services and products backed by audited financial primitives, institutions that don’t have DeFi-specific teams are now able to easily access DeFi. The upgrade’s capabilities set the stage for large-scale institutional partnerships in the pipeline for Spool, following a steady stream of integrations and collaborations leading up to its launch.

“We are incredibly proud to launch Spool V2 after countless months of our team developing, testing, and listening to the feedback and needs of our institutional partners,” says Philipp Zimmerer, Lead of Token Strategy of Spool. “This lands at a pivotal moment in crypto in a year that has been all about responsibly rebuilding the industry and forging a new path for DeFi. Improving access, flexibility, and security will not only garner further institutional support but set a new standard for what DeFi can make possible for any investor.”

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SquaredFinancial embarks on the next phase of growth, setting the backbone of business success

Published

1 week ago

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November 20, 2023

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Founder and CEO of SquaredFinancial Group Philippe Ghanem, a 20-year veteran in the financial industry, had issued, at the beginning of this quarter, an inspiring call for talent to join his leading company, highlighting that people are the cornerstone of any successful enterprise, catalysing growth and steering innovation.

As the Group embarks on an exciting phase of expansion and growth, it bolsters its leadership team with six industry-seasoned executives. The latest key appointments will strengthen the current team comprised of industry experts and professionals, which had laid the groundwork for a revolutionary path.

SquaredFinancial Group’s exceptional journey in financial technology since 2005 has been marked by innovation and an unwavering commitment to providing top-tier service to investors around the world. Fuelled by a steadfast vision, the company, alongside its management and team, has always stayed at the forefront by leveraging cutting-edge technology, offering a diverse range of services to investors.

The new appointments:

Craig Jenkins, Chief Legal & Compliance Officer. He brings more than 16 years of expertise in Legal, AML and Compliance, and will oversee the consolidation and health of the compliance system.

Thomas Selby, Chief Sales Officer. With 15 years of experience in sales and business development in prime FinTech and online trading, he will lead the business development strategy to drive more revenue growth.

Thomas Selby, Chief Sales Officer. With 15 years of experience in sales and business development in prime FinTech and online trading, he will lead the business development strategy to drive more revenue growth.

Dominique El Khoury, Global Head of Sales and Business Development – GCC & MEA. Having 12 years of experience in the trading industry, he will spearhead the expansion of sales initiatives and business growth within the region.

Drosoula Hadjisavva, Chief Marketing Officer. With 13 years of proven track record in heading global marketing operations across leading fintech, she will be responsible for redefining the marketing strategy and brand positioning.

Spyros Andreou, Chief Technology Officer. With a stellar background in IT and network engineering, he will harness and leverage technology to optimize organizational and operational performance and security.

Catharine Ioannou, Chief Human Resources Officer. With proven expertise in human resources, talent acquisition and advancement, she will steer the company’s efforts to create a more inclusive workforce, nurture loyalty and foster a culture of merit and excellence.

Commenting on the announcement, Philippe Ghanem said: “People are catalysers of growth and drivers of innovation. I’m happy to welcome these new forward-thinking minds, as their arrival marks a significant milestone for SquaredFinancial. Each of them has proven expertise and will bring, in strong collaboration with the current team of talents, strategic value and experience to the company, further shaping its future. But most of all, I feel deep responsibility towards all our stakeholders – our employees, our clients and our shareholders – as we write this new chapter of our company’s 15-year legacy. The rapid growth that our company has witnessed over the past couple of years has forged new challenges but also great opportunities, and we are well-positioned to seize them, today more than ever. The industry is witnessing transformative change, and we are more than ever committed to supporting our customers with passion, professionalism and dedication to address their needs with the utmost standards they deserve.”

The recently appointed executives will join the current leadership team comprised of:

Philippe Ghanem, Founder and CEO
Manie Van Rooyen, Partner and Chief Operations Officer
Ali Rupani, Partner and Global Head of Front Office
Stathis Flangofas, Group Chief Financial Officer
Philios Petrides, Chief Data & Product Officer
Noureldeen Hammoury, Chief Market Analyst
Chrysovalantis Karageorgiou, Global Head of Operations
Constantinos Ghalanos, Head of Dealing

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