Connect with us
European Gaming Congress 2024

Fintech

Medscheme Transforms Claims Management Efficiency using FICO Decision Technology

Published

on

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.

More information

“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.

Advertisement
Stake.com

“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.”

Advertisement
Stake.com

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

How to identify authenticity in crypto influencer channels

Published

on

 

Modern brands stake on influencer marketing, with 76% of users making a purchase after seeing a product on social media.The cryptocurrency industry is no exception to this trend. However, promoting crypto products through influencer marketing can be particularly challenging. Crypto influencers pose a significant risk to a brand’s reputation and ROI due to rampant scams. Approximately 80% of channels provide fake statistics, including followers counts and engagement metrics. Additionally, this niche is characterized by high CPMs, which can increase the risk of financial loss for brands.

In this article Nadia Bubennnikova, Head of agency Famesters, will explore the most important things to look for in crypto channels to find the perfect match for influencer marketing collaborations.

 

  1. Comments 

There are several levels related to this point.

 

Advertisement
Stake.com

LEVEL 1

Analyze approximately 10 of the channel’s latest videos, looking through the comments to ensure they are not purchased from dubious sources. For example, such comments as “Yes sir, great video!”; “Thanks!”; “Love you man!”; “Quality content”, and others most certainly are bot-generated and should be avoided.

Just to compare: 

LEVEL 2

Don’t rush to conclude that you’ve discovered the perfect crypto channel just because you’ve come across some logical comments that align with the video’s topic. This may seem controversial, but it’s important to dive deeper. When you encounter a channel with logical comments, ensure that they are unique and not duplicated under the description box. Some creators are smarter than just buying comments from the first link that Google shows you when you search “buy YouTube comments”. They generate topics, provide multiple examples, or upload lists of examples, all produced by AI. You can either manually review the comments or use a script to parse all the YouTube comments into an Excel file. Then, add a formula to highlight any duplicates.

LEVEL 3

It is also a must to check the names of the profiles that leave the comments: most of the bot-generated comments are easy to track: they will all have the usernames made of random symbols and numbers, random first and last name combinations, “Habibi”, etc. No profile pictures on all comments is also a red flag.

 

Advertisement
Stake.com

LEVEL 4

Another important factor to consider when assessing comment authenticity is the posting date. If all the comments were posted on the same day, it’s likely that the traffic was purchased.

 

2. Average views number per video

This is indeed one of the key metrics to consider when selecting an influencer for collaboration, regardless of the product type. What specific factors should we focus on?

First & foremost: the views dynamics on the channel. The most desirable type of YouTube channel in terms of views is one that maintains stable viewership across all of its videos. This stability serves as proof of an active and loyal audience genuinely interested in the creator’s content, unlike channels where views vary significantly from one video to another.

Many unauthentic crypto channels not only buy YouTube comments but also invest in increasing video views to create the impression of stability. So, what exactly should we look at in terms of views? Firstly, calculate the average number of views based on the ten latest videos. Then, compare this figure to the views of the most recent videos posted within the past week. If you notice that these new videos have nearly the same number of views as those posted a month or two ago, it’s a clear red flag. Typically, a YouTube channel experiences lower views on new videos, with the number increasing organically each day as the audience engages with the content. If you see a video posted just three days ago already garnering 30k views, matching the total views of older videos, it’s a sign of fraudulent traffic purchased to create the illusion of view stability.

Advertisement
Stake.com

 

3. Influencer’s channel statistics

The primary statistics of interest are region and demographic split, and sometimes the device types of the viewers.

LEVEL 1

When reviewing the shared statistics, the first step is to request a video screencast instead of a simple screenshot. This is because it takes more time to organically edit a video than a screenshot, making it harder to manipulate the statistics. If the creator refuses, step two (if only screenshots are provided) is to download them and check the file’s properties on your computer. Look for details such as whether it was created with Adobe Photoshop or the color profile, typically Adobe RGB, to determine if the screenshot has been edited.

LEVEL 2

After confirming the authenticity of the stats screenshot, it’s crucial to analyze the data. For instance, if you’re examining a channel conducted in Spanish with all videos filmed in the same language, it would raise concerns to find a significant audience from countries like India or Turkey. This discrepancy, where the audience doesn’t align with regions known for speaking the language, is a red flag.

If we’re considering an English-language crypto channel, it typically suggests an international audience, as English’s global use for quality educational content on niche topics like crypto. However, certain considerations apply. For instance, if an English-speaking channel shows a significant percentage of Polish viewers (15% to 30%) without any mention of the Polish language, it could indicate fake followers and views. However, if the channel’s creator is Polish, occasionally posts videos in Polish alongside English, and receives Polish comments, it’s important not to rush to conclusions.

Advertisement
Stake.com

Example of statistics

 

Wrapping up

These are the main factors to consider when selecting an influencer to promote your crypto product. Once you’ve launched the campaign, there are also some markers to show which creators did bring the authentic traffic and which used some tools to create the illusion of an active and engaged audience. While this may seem obvious, it’s still worth mentioning. After the video is posted, allow 5-7 days for it to accumulate a basic number of views, then check performance metrics such as views, clicks, click-through rate (CTR), signups, and conversion rate (CR) from clicks to signups.

If you overlooked some red flags when selecting crypto channels for your launch, you might find the following outcomes: channels with high views numbers and high CTRs, demonstrating the real interest of the audience, yet with remarkably low conversion rates. In the worst-case scenario, you might witness thousands of clicks resulting in zero to just a few signups. While this might suggest technical issues in other industries, in crypto campaigns it indicates that the creator engaged in the campaign not only bought fake views and comments but also link clicks. And this happens more often than you may realize.

Summing up, choosing the right crypto creator to promote your product is indeed a tricky job that requires a lot of resources to be put into the search process. 

Author Nadia Bubennikova, Head of agency  at Famesters

Author

Advertisement
Stake.com

Nadia Bubennikova, Head of agency at Famesters

Continue Reading

Fintech

Central banks and the FinTech sector unite to change global payments space

Published

on

central-banks-and-the-fintech-sector-unite-to-change-global-payments-space

 

The BIS, along with seven leading central banks and a cohort of private financial firms, has embarked on an ambitious venture known as Project Agorá.

Named after the Greek word for “marketplace,” this initiative stands at the forefront of exploring the potential of tokenisation to significantly enhance the operational efficiency of the monetary system worldwide.

Central to this pioneering project are the Bank of France (on behalf of the Eurosystem), the Bank of Japan, the Bank of Korea, the Bank of Mexico, the Swiss National Bank, the Bank of England, and the Federal Reserve Bank of New York. These institutions have joined forces under the banner of Project Agorá, in partnership with an extensive assembly of private financial entities convened by the Institute of International Finance (IIF).

Advertisement
Stake.com

At the heart of Project Agorá is the pursuit of integrating tokenised commercial bank deposits with tokenised wholesale central bank money within a unified, public-private programmable financial platform. By harnessing the advanced capabilities of smart contracts and programmability, the project aspires to unlock new transactional possibilities that were previously infeasible or impractical, thereby fostering novel opportunities that could benefit businesses and consumers alike.

The collaborative effort seeks to address and surmount a variety of structural inefficiencies that currently plague cross-border payments. These challenges include disparate legal, regulatory, and technical standards; varying operating hours and time zones; and the heightened complexity associated with conducting financial integrity checks (such as anti-money laundering and customer verification procedures), which are often redundantly executed across multiple stages of a single transaction due to the involvement of several intermediaries.

As a beacon of experimental and exploratory projects, the BIS Innovation Hub is committed to delivering public goods to the global central banking community through initiatives like Project Agorá. In line with this mission, the BIS will soon issue a call for expressions of interest from private financial institutions eager to contribute to this ground-breaking project. The IIF will facilitate the involvement of private sector participants, extending an invitation to regulated financial institutions representing each of the seven aforementioned currencies to partake in this transformative endeavour.

Source: fintech.globa

The post Central banks and the FinTech sector unite to change global payments space appeared first on HIPTHER Alerts.

Advertisement
Stake.com
Continue Reading

Fintech

TD Bank inks multi-year strategic partnership with Google Cloud

Published

on

td-bank-inks-multi-year-strategic-partnership-with-google-cloud

 

TD Bank has inked a multi-year deal with Google Cloud as it looks to streamline the development and deployment of new products and services.

The deal will see the Canadian banking group integrate the vendor’s cloud services into a wider portion of its technology solutions portfolio, a move which TD expects will enable it “to respond quickly to changing customer expectations by rolling out new features, updates, or entirely new financial products at an accelerated pace”.

This marks an expansion of the already established relationship between TD Bank and Google Cloud after the group previously adopted the vendor’s Google Kubernetes Engine (GKE) for TD Securities Automated Trading (TDSAT), the Chicago-based subsidiary of its investment banking unit, TD Securities.

Advertisement
Stake.com

TDSAT uses GKE for process automation and quantitative modelling across fixed income markets, resulting in the development of a “data-driven research platform” capable of processing large research workloads in trading.

Dan Bosman, SVP and CIO of TD Securities, claims the infrastructure has so far supported TDSAT with “compute-intensive quantitative analysis” while expanding the subsidiary’s “trading volumes and portfolio size”.

TD’s new partnership with Google Cloud will see the group attempt to replicate the same level of success across its entire portfolio.

Source: fintechfutures.com

The post TD Bank inks multi-year strategic partnership with Google Cloud appeared first on HIPTHER Alerts.

Advertisement
Stake.com
Continue Reading

Trending