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 $43 million in previously undetected future high-cost claimants
Identified $68M more stop loss dollars that were missed by other tools
A 20% increased capture of future risk across major condition categories
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
This large regional health plan serves more than 2 million people, from individuals and families to employees of Fortune 100 companies.
Discover how Prealize helped the client to uncover 14% more future high-cost claimants.