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The Insurance industry is evolving at an exponential pace. Changing customer expectations are forcing innovations that require ever evolving business models to keep up. Customers are demanding digital solutions that are convenient and personalized. Insurers and vendors are responding in a variety of ways with “tried and true” as well as new technology as centerpiece solutions.

4AISoft is at the forefront of these trends moving the insurance industry towards a secure and digitally integrated ecosystem. Our solutions provide an intuitive and seamless user experience without being overly complex. Our unique blend of predictive analytics supported by customized AI modeling, provides unprecedented insight into full-life cycle, customer behaviors. Our high quality data-sets coupled with 4AISoft’s superior AI modeling and training deliver significant improvements for all aspects of executive decision making.

Custom software applications and Robotic software automation greatly streamline workflows and improved operations. Leaving our clients free to redeploy their valuable human assets into critical, priority and sensitive roles. Our team of highly trained subject matter experts ( SMEs) is available to assist your professional claims team by recommending leading solutions that are practical to your needs.

With our clients handling sensitive PII ( personally identifiable information ) data, our team of InfoSec professionals will help you create a secure network environment as well as robust security-aware applications.

Our dedicated team of professionals ensures that our clients have the appropriate resources to continue delivering compelling value to end customers – before, during and post-implementation.

Klear.ai

Fraud Detection

The Klear.ai Fraud Detection System is potent and highly accurate.

Our system flags potential abuse and fraud within workers comp claims. Powered by AI and ML, the solution has a library of algorithms built to detect Claimant Fraud, Provider Fraud and Vendor Fraud.

Severity Scoring

Severity Prediction Models predict the severity of every claim throughout its’ lifecycle.

Accurate predictions can help lower your claim cost by assigning the right adjuster or by making critical decisions regarding case management early in the claim’s lifecycle.

Reserve Scoring

Proprietary models give targeted reserve recommendations for every claim.

Our recommendations are based on a survey of historical data including claimant demographics, injury specifics, procedures, prescriptions and other compounding factors like comorbidity.

Litigation Scoring

Predicting the likelihood of a claim going to litigation is a valuable tool for your program.

The Klear.ai model provides expected probability along with other top drivers resulting in a probabilistic score which greatly improves the lifecycle management of the claim.

Subrogation Scoring

SUBROGATION SCORING

Our model identifies claims with the potential to recover money through subrogation.

The system further prioritizes and channels these claims to designated subrogation specialists within your organization.

Reserve Scoring

Proprietary models give targeted reserve recommendations for every claim.

Our recommendations are based on a survey of historical data including claimant demographics, injury specifics, procedures, prescriptions and other compounding factors like comorbidity.

Workers' Comp Claims Analytics

MEMBER MANAGEMENT

PROVIDER MANAGEMENT

The 4aiSoft Edge

Off-Shore Capabilities

We bring proven outsourcing engagement models to clients looking to exploit talent availability with cost advantages. The models are flexible, scalable, secure and are customized to your specific needs.

Capable Team

Our talent pool is rich and diverse, allowing us to work with a multitude of platforms and programming languages.

Flexible & Adapatbale

We are just ‘right-sized’ ! Not too big, nor too small. And we take our size as an advantage, as this gives us the flexibility to adapt to your engagements.

Healthcare Domain Expertise

Our solutions are an amalgamation of deep domain knowledge and strong technology skills. With over 1500 man-hours of experience in Insurance & Healthcare domains, the team has worked with leading companies over a wide array of challenging projects.

Services

Claims Payer Solutions

4aiSoft works with leading health insurers and TPAs to manage their claims adjudication and related services.

 

Predictive Analytics

4aiSoft Analytics Solution helps you leverage your data to reveal detailed insights, helping you make informed decisions – Strategic, Operational or Tactical.

Application Development

4aiSoft is driven by the transformative potential of advanced digital and connected technology to radically improve client outcomes. Our teams of experienced programmers deliver a singular focus on top tier solutions in the insurance-tech domain

Claims Provider Solutions

4aiSoft provides end to end revenue cycle management services to hospitals. Our services span multiple functional applications including – charge capture, claim creation and submission, coding, collection and follow-ups, denial management, payment posting, appeals and reporting.

Services

Claims Payer Solutions

4aiSoft works with leading health insurers and TPAs to manage their claims adjudication and related services.

 

Claims Provider Solutions

4aiSoft provides end to end revenue cycle management services to hospitals. Our services span multiple functional applications including – charge capture, claim creation and submission, coding, collection and follow-ups, denial management, payment posting, appeals and reporting.

Predictive Analytics

4aiSoft Analytics Solution helps you leverage your data to reveal detailed insights, helping you make informed decisions – Strategic, Operational or Tactical.

Application Development

4aiSoft is driven by the transformative potential of advanced digital and connected technology to radically improve client outcomes. Our teams of experienced programmers deliver a singular focus on top tier solutions in the insurance-tech domain

Subrogation Scoring

SUBROGATION SCORING

Our model identifies claims with the potential to recover money through subrogation.

Reserve Scoring

Proprietary models give targeted reserve recommendations for every claim.

SEVERITY SCORING

Predict the severity of your workers comp claims and prevent the nasty claims.

RESERVE PREDICTION

Estimate your reserves to prevent under and over reserving and maximize your savings!