Predict high-cost claimants at the individual and group level to fuel stop-loss underwriting decisions that grow your business.
AI tailored to your unique populations provides detailed insights into diagnoses and prescriptions driving future cost predictions. This enables you to accurately project high-cost and low-cost member risk for more competitive pricing.
Identify high-cost claimants and their future dollar value, at the individual and group level. That means better insights, more competitive pricing, and more revenue for you.
Price your products more competitively with highly precise high-cost claimant projections that secure your renewals and drive new business — across all self-funded groups.
Get predictions that are up to twice as accurate as any other solution — especially during atypical utilization periods like a pandemic
Find patterns undetectable to the human eye, so that you don't overprice groups whose risk will go down or underprice groups whose risk will go up. That means you can offer the most competitive rate to your book.
Support the underwriting workflow through a standalone tool or seamless integration with existing workflows.
Uncovered over $40 million in previously undetected future high-cost claimants, across major condition categories such as cancer, transplant, chronic psychiatric disorders, and specialty Rx
Provided predictions 12 months before diagnoses hit claims so that the plan could act earlier
Identified next year's high-cost claimants with 2x accuracy based on SOA comparative methodology
RiskInsight reveals hidden member-level insights into future high-cost and low-cost claimants that would otherwise be missed by relying on experience alone. Our advanced AI solution also identifies diagnostic and prescription indicators of future risks at the member level. By find previously unidentified high-cost claimants even without incurred claims, and providing future point estimates, RiskInsight supports underwriter triangulation to price stop loss competitively, grow margin, and win new business.
Underwriter, Large Blues Plan
SVP, Underwriting, Large Blues Plan
Underwriter, Large Blues Plan
We used our predictive analytics technology to determine how 2020 COVID-19 healthcare utilization declines will impact healthcare in 2021.
View the results, including the top three conditions most at risk of increased diagnoses.
Palo Alto office
745 Emerson Street Palo Alto, CA 94301