RiskInsight

Find future high-cost claimants.
Underwrite the future, not the past.

Predict high-cost claimants at the individual and group level to fuel stop-loss underwriting decisions that grow your business.

Who needs RiskInsight?

For underwriters

  • Complement your market knowledge and help triangulate price
  • Increase your stop-loss margins
  • Grow your stop-loss business
  • Price competitively
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Why you need RiskInsight

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 future high-cost claimants

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.

Grow stop-loss margins

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.

Increase accuracy and trust

Get predictions that are up to twice as accurate as any other solution — especially during atypical utilization periods like a pandemic

Protect yourself from regression to the mean

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.

Optimize workflows

Support the underwriting workflow through a standalone tool or seamless integration with existing workflows.

Results

Better
Visibility

$40m

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

More
Proactive

12+

Provided predictions 12 months before diagnoses hit claims so that the plan could act earlier

Greater
Precision

2x

Identified next year's high-cost claimants with 2x accuracy based on SOA comparative methodology

How RiskInsight works

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.

  • Enables group level risk allocation
  • Insight into individual changes in costs allows for more protection from data gaps, regression to the mean and unseen new high cost
  • Insight into previously unidentifiable high-cost claimants and future point estimates and likelihoods on high-cost claimants

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What our customers say

"RiskInsight gives me the information I need to back up the rates I give to the account manager."

Underwriter, Large Blues Plan

"This is cutting edge."

SVP, Underwriting, Large Blues Plan

"Extremely useful and easy to understand."

Underwriter, Large Blues Plan