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Medscheme Transforms Claims Management Efficiency using FICO Decision Technology

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  • 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

Fintech

Wirex Launches Enhanced Cryptoback™

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Today, payments platform Wirex launched a supercharged update of their revolutionary Cryptoback™ rewards programme. Customers can now earn up to 1.5% back in Bitcoin on Wirex Visa card purchases.

Released in 2018, Cryptoback™ was the world’s first rewards programme that paid out 0.5% in cryptocurrency for all in-store spending with the Wirex Visa card. Thanks to the recent launch of the Wirex Token (WXT), customers can now triple the amount of BTC they earn – making investing in cryptocurrency easier than ever before.

Depending on the amount of WXT held, in-store Wirex card purchases now generate up to 1.5% in Bitcoin. There are three levels of crypto rewards available:

  • 500,000 WXT = 1.5% Cryptoback™
  • 100,000 WXT = 1.0% Cryptoback™
  • 50,000 WXT = 0.75% Cryptoback™

Wirex have calculated that the average UK consumer stands to earn more than £300 in Cryptoback™ every year, just by using their Wirex Visa card for day-to-day spending. Unlike many other cashback programmes, Wirex doesn’t impose restrictions on what customers can do with their rewards. Cryptoback™ can be redeemed instantly into their Bitcoin accounts, or quickly and easily exchanged into fiat for spending.

Enhanced Cryptoback™ is just one of the ways that holding Wirex Tokens allows customers to get even more out of their account. They can also enjoy heavily discounted fees based on the same structure, with access to premium products, merchant offers and airport lounges coming soon. As Wirex co-founder Pavel Matveev explains:

“We created the Wirex Token to be something that provides tangible value and benefits for holders beyond its market trajectory. Enhanced Cryptoback™ is the perfect example of this, as it allows customers to earn and invest in digital currency with a minimum of fuss. We’re looking forward to introducing even more benefits for WXT holders soon.”

 

SOURCE Wirex

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Aegis Capital Corp. is pleased to announce its commitment to Equity Research

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Aegis Capital Corp. continues to expand its equity research platform with the addition of Benjamin Zucker and James Jang. Benjamin joined in May 2019 as Head of Specialty Finance and James joined in June 2019 to head up the Maritime & Special Situations. These new coverage areas will bolster Aegis’ existing research footprint in the Internet/TMT and Healthcare sectors.

Mr. Zucker joined Aegis from BTIG LLC, where he was a Director and lead analyst covering Mortgage REITs and real estate finance companies. Prior to BTIG, Mr. Zucker was a Vice President at JMP Securities LLC where he covered similar sectors. Benjamin began his career in equity research at Pritchard Capital Partners. At Aegis, Mr. Zucker’s coverage will span across several Specialty Finance sub-sectors including Mortgage REITs, Equity REITs, Business Development Companies (BDCs) and Financial Technology firms (FinTech). Benjamin’s current coverage list includes: Medalist Diversified REIT (MDRR), Sachem Capital Corp. (SACH), and Saratoga Investment Corp. (SAR).

Mr. Jang joined Aegis from Maxim Group LLC, where he was a Senior Vice President and lead analyst covering the Industrials, Infrastructure and Clean-Technology sectors. Previously, Mr. Jang was a senior analyst at Sidoti & Co. covering furniture and textiles and was an equity research associate at Canaccord Genuity covering Maritime and Upstream E&P companies. Since joining, Mr. Jang has expanded Aegis’ research platform into the Agriculture, Oilfield Services, and Industrial Technology sectors with coverage of Profire Energy (PFIE), Marrone Bio Innovations (MBII), Yield10 Bioscience (YTEN) and Sigma Labs (SGLB).

Michael Pata Aegis’ Head of Business Development commented: “Hiring Benjamin and James continues to show Aegis’ commitment to equity research, which brings institutional quality analysis to the small and mid-cap universe.”

 

SOURCE Aegis Capital

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LexinFintech Announces US$300 Million Private Placement of Convertible Notes with PAG

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LexinFintech Holdings Ltd. (NASDAQ: LX) (“Lexin” or the “Company”), a leading fintech platform for educated young adults in China, today announced that it has entered into a convertible note purchase agreement with PAG, a leading Asia-focused private equity firm with over US$30 billion in capital under management, pursuant to which the Company will issue and sell convertible notes in an aggregate principal amount of US$300 million to PAG through a private placement. The private placement is subject to satisfaction of customary closing conditions and is expected to close on or around September 16, 2019. The gross proceeds raised from this placement will be approximately US$296.4 million.

The convertible notes will mature in seven years, bearing interest at a rate of 2.0% per annum. The notes will be convertible into fully paid Class A ordinary shares of the Company or ADSs at a conversion price of US$14 per ADS at the holder’s option from the date that is six months after the issuance date.  The holder of the notes will have the right to require the Company to repurchase for cash all or any portion of the notes on the fourth anniversary of the issuance date.

At closing, the Company will appoint to its Board of Directors one person designated by PAG.

Mr. Jay Wenjie Xiao, Founder, chairman and chief executive officer of the Company, said, “We are excited to have PAG as our new investor. This investment will enable Lexin to further develop and enhance our consumption-based ecosystem, improve product offerings to our educated adult customers, continue to invest in technology, build up additional consumption scenarios, and provide more consumer benefits to our customers.”

“PAG has a strong commitment to and deep understanding of China’s financial services industry, and we have a demonstrated track record of seeking out and engaging with the industry’s leading companies,” said PAG Chairman & CEO Weijian Shan. “Lexin has an unparalleled platform for meeting young consumers’ credit needs while strictly controlling and minimizing credit risks, which makes it unique, and we are looking forward to supporting the company as it embarks on its next stage of growth.”

Goldman Sachs (Asia) L.L.C., BofA Merrill Lynch and China Renaissance acted as the private placement agents to Lexin on the transaction.

 

SOURCE LexinFintech Holdings Ltd.

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