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AI-Powered Claims Adjudication in Health Insurance: Cost Containment & Fraud Detection - Innovation & R&D

Former SVP, Audit Director - Global Financial Crimes
Bank of America
Insurance
USA
North America

$ 795

June 18, 2025

Topics covered in this transcript

  • How does NLPextract diagnoses from unstructured clinical notes?
  • What graphanalytics detect provider fraud networks?
  • How are priorauthorization workflows automated?
  • Whatexplainability frameworks meet state insurance regulations?
  • How do modelsbenchmark treatment costs against regional averages?
  • Whatprivacy-preserving techniques protect patient data?
  • How are appealrates reduced through transparent AI decisions?
  • What clinicalcoding validation systems prevent upcoding?
  • How dopredictive models flag outlier billing patterns?
  • What ROI metricsjustify AI implementation costs?
  • How are providerperformance scores integrated into pricing?
  • What disasterrecovery plans exist for system outages?

Keywords

  • Medical NLP
  • Claims Triage
  • Fraud Networks
  • Prior Authorization
  • Clinical Coding
  • Provider Analytics
  • Regulatory Compliance
  • Appeal Rates
  • Patient Privacy
  • Cost Benchmarking
  • Model Explainability
  • ROI Analysis

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Jakarta

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Mumbai
4th Floor, Pinnacle Business Park, Andheri East, Mumbai, 400093
Bangalore

Cinnabar Hills, Embassy Golf Links Business Park, Bengaluru, Karnataka 560071
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Get in touch with us to learn more about our services, ask for assistance with a technical difficulty, or if you would like a product demo.
info@nextyn.com
Singapore
68 Circular Road, #02-01
049422, Singapore
Jakarta

Revenue Tower, Scbd, Jakarta 12190, Indonesia
Mumbai
4th Floor, Pinnacle Business Park, Andheri East, Mumbai, 400093
Bangalore

Cinnabar Hills, Embassy Golf Links Business Park, Bengaluru, Karnataka 560071
Instagram Favicon

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