Connect with us

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.

“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

360Quadrants Recognizes IBM, Microsoft and Salesforce as Visionary Leaders in the AI in Fintech Space

Published

on

Reading Time: 2 minutes

AI in Fintech solutions are used by enterprises to perform finance-related tasks that traditionally require human intelligence. These solutions leverage AI-equipped technology to allow the financial sector to design better investment strategies, swiftly detect anomalies, recognize patterns in data, implement voice recognition, and engage in thorough market analysis. Simply put, the AI in Fintech market hosts vendors that provide AI-enabled Fintech solutions.

360Quadrants the most granular comparison platform has released a quadrant on AI in Fintech Solutions to help businesses make quicker and more informed decisions. The quadrant has IBMMicrosoft and Salesforce sharing space as Visionary Leaders. 360Quadrants are generated post analysis of companies (product portfolios and business strategy). Quadrants will be updated every three months based on market and regional analysis and developments in AI in Fintech.

AI in Fintech Solutions Quadrant Highlights

360Quadrants covers 79 companies in the AI in Fintech Solutions space and places the top 44 of them in a quadrant depending on their quality, reliability, and business outcome. These 44 companies are categorized into Visionary Leaders, Dynamic Differentiators, Emerging Companies, and Innovators.

360Quadrants recognizes Intel Movidius Neural Compute Stick, Amazon AWS Alexa, Salesforce Einstein, Google Cloud Platform, Microsoft Cortana Intelligence Suite, and IBM Watson Platform as Visionary Leaders; IPSoft Amelia, ComplyAdvantage, Nuance Virtual Assistance, Inbenta InbentaBot, Digital Reasoning Conduct Surveillance as Innovators; Samsung and Microstrategy HyperIntelligence as Dynamic Differentiators; and DataRobot, Razorthink Big Brain, Numenta HTM for Stocks suite, Anodot AI Analytics, Brighterion Smart Agents, Kasisto Kai BankingNext IT AlmeZestFinance ZAML, Ayasdi Enterprise AI, Voyager Analytics, AlphaSense and Wallet. AI as Emerging Companies. The 360Quadrants platform provides the most granular AI in Fintech Solutions comparisons between vendors.

Additionally, 360Quadrants has dived deep into research and released a niche region-specific quadrant. This quadrant recognizes the top player in the market in specific regions. The regional quadrant covers North AmericaEuropeAsia PacificMEA, and Latin America. Intensive research was conducted to place companies in regional quadrants based on their developments, presence—both online and physical—and support/reach in specific regions. IBM Watson, Salesforce, and Microsoft are recognized as Visionary Leaders across regions. In the North America and Asia Pacific regions, Intel Movidius Neural Compute Stick is recognized as a Visionary Leader by 360Quadrants. Finally, for Latin America and MEA, 360Quadrants recognizes AWS as a Visionary Leader.

Methodology

The methodology used to rank AI in Fintech Solutions companies involved the use of extensive secondary research to identify key vendors by referring to annual reports, press releases, investor presentations, white papers, and various related directories and databases. 44 key vendors were shortlisted based on their breadth of product offerings, organization size, and other criteria. The scores and weights for shortlisted vendors against each parameter were finalized post research.  After the finalization of ratings, each vendor was placed in the most relevant quadrant based on their score in the product offering and business strategy parameters.

 

SOURCE 360Quadrants

Continue Reading

Fintech

Infinicept Achieves 5X Growth Putting FinTech and SaaS Companies on the Fast Track as Payment Facilitators

Published

on

Reading Time: 2 minutes

 

As the payment facilitator market continues its trajectory of nearly 80% CAGR, representing $500 billion in total transaction volume by 2021, Infinicept is quickly capturing market share as the first and only open, agnostic payment facilitator platform. Since the company’s launch in 2012, Infinicept has helped fast track over 200 payment facilitators by offering consulting services and products that greatly reduce the time it takes to embed payment acceptance into software offerings. This momentum continues in 2019 as Infinicept records 500 percent growth in revenue and customer acquisition.

Recognizing the potential for further growth, Mastercard has invited Infinicept to join Start Path, a six month program that connects innovative later-stage startups to Mastercard’s global ecosystem.

“Having evaluated 10,000 startups from across the globe, we are always adding ground-breaking entrepreneurs to our network of innovators,” said Amy Neale, Mastercard vice president and global lead for Start Path. “Mastercard Start Path companies today are later-stage startups reaching unicorn status, entering the public markets and co-creating with world-renowned financial services firms to deliver real solutions for consumers.”

As the payment facilitator model matures, hundreds of thousands FinTech and software as a service (SaaS) companies worldwide are realizing they can provide a better customer experience and increase revenues and valuation by becoming a payment facilitator. The main obstacle being the time it takes to become a payment facilitator and the risks that come with onboarding submerchants. Payment Facilitator in a Box™ was developed by Infinicept to provide companies with the merchant underwriting and back office platform they need to easily get up and running—in weeks, not years.

Infinicept has already attracted customers in a variety of vertical markets who recognize the benefits and return on investment (ROI) this payment model offers.  Signed customers include businesses in retail, food and beverage, healthcare, real estate, events and many more.

“Within the healthcare industry, there is a huge demand for a more positive payment experience. Patients expect modern, intuitive payment tools and large health systems need the flexibility to respond to their patients’ financial needs by rolling out consumer-friendly payment options across their enterprise,” said Alan Nalle, Chief Strategy Officer of Patientco. “Leveraging Infinicept’s innovative Payment Facilitator in a Box™, Patientco simplifies the complexities of implementing, managing and scaling new payment technology for health systems while providing a superior financial experience that today’s patients expect.”

“FinTech and SaaS companies see the value of integrating merchant acceptance, underwriting, onboarding and back office operations into their products, but in order to do that, they need a supporting platform that reduces the complexities of it and works with any bank, processor, gateway or CRM they choose,” said Deana Rich, Co-Founder and Co-CEO of Infinicept. “Achieving 500 percent revenue growth and joining the Mastercard Start Path program confirms Infinicept is on the right path to fill a critical market need for FinTech and SaaS companies. Our engineering team and partners have done a great job delivering a dynamic suite of open and automated services that provide an operational backbone for any company looking to take the simple path to becoming a payment facilitator.”

 

SOURCE Infinicept

Continue Reading

Fintech

Guaranteed Rate Appoints Suk Shah as Chief Financial Officer

Published

on

Reading Time: 2 minutes

 Guaranteed Rate, one of the largest retail mortgage lenders in the nation, has hired Suk Shah as its Chief Financial Officer to accelerate growth. As Guaranteed Rate continues to break monthly volume records, it has been named one of 2019 Chicago’s largest privately held companies, reporting nearly $24 Billionof overall loan volume in 2018 alone.

“Suk is a huge hire for Guaranteed Rate and is a perfect cultural fit,” said Founder & CEO Victor Ciardelli. “With an extensive background as a FinTech CFO, he brings a ton of experience to the company, including areas such as mergers and acquisitions.”

As CFO, Shah will lead and oversee Guaranteed Rate’s focus on profitability and efficiency, while supporting various growth strategies and initiatives. Shah’s presence will enable Guaranteed Rate to expand the company’s product, technology and service solutions that will further enable the business to drive revenue growth and margin expansion across the organization.

“Guaranteed Rate is a pioneer in the digital mortgage industry and is uniquely positioned as an industry leader to drive mortgage volume and revenue through its innovative products and services,” said Shah. “I’m looking forward to joining this highly tenured and passionate leadership team to make a transformative impact for the company.”

Shah joins the Guaranteed Rate team from his former position of nearly five years at a high-growth financial technology company, where he helped raise over $600 million in equity and $4 billion in debt capital. Before that, Suk was the CFO of the US and Canadian divisions of a Global Commercial Bank where he oversaw a $40 billion loan and deposit. Shah began his career with General Electric and spent over eight years with the company in various finance and operating roles, helping to execute business priorities and deliver financial commitments.

Shah has a Bachelor’s degree in Finance and Information Systems from the University of Illinois and an Executive MBA from Northwestern University.  He lives in Hinsdale, Ill., with his wife and two children.

Guaranteed Rate has delivered competitive pricing, mortgage products and unmatched expertise from its top-producing loan officers, helping thousands of customers move into their dream homes. The Company introduced the market’s first Digital Mortgage, creating an easy-to-understand, transparent loan process, which has led to an industry-leading customer satisfaction rating and exponential growth.

 

SOURCE Guaranteed Rate

Continue Reading

Trending

Thefintechbuzz is a news publishing website which digests / hand picks the latest news about the financial industry industry, and serves them to you daily.

Contact us: pressroom@thefintechbuzz.com

© Thefintechbuzz.com 2019 - part of PICANTE Media. All rights reserved. Registered in Romania under Proshirt SRL, Company number: 2134306, EU VAT ID: RO21343605. Office address: Blvd. 1 Decembrie 1918 nr.5, Targu Mures, Romania