Wipro partners with US-based firm to develop health insurance solution

14 June 2018 Consultancy.in 3 min. read

Indian IT consulting giant Wipro has entered into a partnership with US-based data analytics firm Opera Solutions to develop a secure and efficient technique to screen insurance claims in the US. The new product leverages the artificial intelligence (AI) capabilities of Opera Solutions, combined with Wipro’s expertise in the forensics and audit domains. 

Founded in New York in 2004, Opera Solutions is primarily a software firm engaged in designing complex programmes for data analytics and subsequent profit maximisation. The firm employs a combination of Big Data analytics and computational capacity to serve clients in the financial services, professional services, telecom, retail, and healthcare sectors, among a range of others.

In partnership with Indian tech firm Wipro, the firm has now developed a comprehensive solution that caters specifically to the healthcare insurance sector. As the Trump administration continues to systematically dismantle Obamacare – most recently attacking the coverage for pre-existing conditions – the dynamic segment is in more need than ever of a mechanism to ensure vigilance and efficiency.

To this end, the jointly developed solution tackles the issues of fraud, waste and abuse (FWA) within the sector. Opera Solutions has developed a specific FWA detection engine, which relies on AI and machine learning tools to identify anomalies through the firm’s unique risk-scoring algorithms.

Wipro partners with US-based firm to develop health insurance solution

Thus far, most software for the detection of anomalies is applied on an individual case basis, with customised rules and conditions. In contrast, Opera Solutions’ FWA engine relies on entity risk scoring, which involves the assessment of every anomaly across all specialisations in the healthcare sector, thereby creating a more comprehensive solution.

As a result, claims that are exceptionally risky will immediately generate a notification, reducing the quantity of false positives in the sector. Wipro’s team will supplement this software with end-to-end services, including forensic analysis of claims, audits, alterations, negotiations, and recovery.

Auditors at Wipro – who have increasingly been engaging in international alliances for security and efficiency – are confident that the solution will enhance the accuracy of their investigation process, aided by the incorporation of background analysis and reason codes within the solution. Not only will this help filter out risky claims, but it also allows for the review of legitimate claims that have been incorrectly rejected.

Commenting on the new solution, Nagendra Bandaru, Senior Vice President and Global Head of Business Process Services for Wipro said, “As one of the global leaders in healthcare insurance claims services, we are aware of the many limitations of automated rules-based systems for first-line claims review. Opera Solutions’ powerful entity-based AI-powered approach, when combined with Wipro’s deep claims management expertise, will give us an edge in the market and enable us to create tremendous value for health insurers.”

Founder & CEO of Opera Solutions, Arnab Gupta added, “Our strategic relationship with Wipro is a perfect example of the ways in which advanced pattern-based AI and machine learning can allow talented and highly experienced people to become even more effective at what they do. We look forward to working with Wipro to take this powerful new capability to the market.”