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Machine Learning Drives Efficiencies at Claritev

April 10, 2020 Artificial intelligence (AI) has quickly become a part of our everyday lives. It’s the technology behind personal assistants like Siri, Alexa and Google. It’s what allows traffic apps like Waze to route us around traffic and to our destinations in the least amount of time, and it’s how companies like Amazon decide…

April 10, 2020 |
Business man touching a screen with the words "machine learning" displayed

April 10, 2020 Artificial intelligence (AI) has quickly become a part of our everyday lives. It’s the technology behind personal assistants like Siri, Alexa and Google. It’s what allows traffic apps like Waze to route us around traffic and to our destinations in the least amount of time, and it’s how companies like Amazon decide which products to recommend to us.

Claritev is taking advantage of the technology too. Since the summer of 2019, we have been testing use cases for machine learning — a form of AI that enables systems to automatically learn and improve from experience without being explicitly programmed. We are applying machine learning to two different use cases for two different services and plan to implement these projects in the summer of 2020:

• The first is for Negotiation Services, where we are using machine learning to help negotiators prioritize their claim queues. This saves each negotiator valuable time and allows them to focus on claims that bring more value to our clients.

• The second use case is for Payment Integrity. We are applying machine learning to a specific segment of claims routed to our Advanced Code Editing service. For this case we have built a model that learns from past manual review decisions to determine if an edit should be made. This frees up our medical coders and clinicians to spend their time focusing on more complex claims. It also allows for future scalability as we will be able to process more claims with the same resources.

Machine learning presents an opportunity to gain valuable insights from data. As Claritev has a rich source of claims data that we continue to build on each day, this technology is a perfect fit for the company. We are currently making further investments in cutting edge machine learning software to create a stable, scalable, and flexible platform that can be employed for our machine learning needs. Along with these current technology investments, we are actively evaluating other use cases to leverage machine learning to make us more efficient and to generate additional value for our clients.

Engaging insights.

New ideas, proven best practices, and fresh perspectives for the healthcare ecosystem.

  • Your team is great at building trust. I have had nothing but a positive and efficient experience.

    Manager

    Large Midwest health plan

  • These are really important things that we wouldn’t be able to do without a partner like Claritev because, again, we want to look at this stuff holistically across carriers. It would take me four times as long to go into every health plan and do this kind of analysis.

    Executive Vice President

    Large, regional consulting firm/insurance brokerage

  • They (Claritev) are continuously refining and developing the platform to meet my needs.

    A Major Healthcare Provider

  • The Technology Leadership Program has brought my department tremendous value. The well-structured program offers the talented hardworking associates options for their career paths, yet exposes them to high visibility initiatives. Every associate has brought a unique perspective and strong professional skills to the organization.

    Bobby Vincent

    Senior Information Technology Director

  • The Technology Leadership Program associates have a tremendous opportunity before them. To have three years to rotate through various departments within Information Technology before deciding which role/area suits them best.  Depending on their choice and interest, they become a unique blend of technologist, business expert and, eventually, corporate leader.

    Andrew George

    Senior Vice President, Information Technology

  • One of the great successes of the program has been our ability to identify and develop emerging leaders whom contribute in every facet of our business. It hasn’t been just about growing IT leaders, it’s about maturing business leaders for Claritev.

    Ed Ververs

    Senior Director, Telecom & Data Center Management

  • I had the privilege to mentor some of the Technology Leadership Program participants and was fortunate to absorb a member into my team, where he has helped tremendously with new automation techniques. Participants bring in fresh perspectives and extreme enthusiasm to IT here at Claritev. I’m looking forward to adding more.

    Vasu Raghunathan

    Senior Director of Data & Service Delivery

  • You have been a great partner from day one. You collaborate with us until we find a resolution. We look forward to a long-standing partnership.

    Payment Integrity and Performance Manager

  • The things we value most about our partnership with Claritev are not just the reliable, efficient delivery of savings through their MSP and ESRD services, but the fact that they are always willing to come to the table to discuss and collaborate on new and innovative solutions that nobody else in the industry has yet to try.

    Drew Satriano, VP of Payment Integrity

    Highmark, Inc.

  • In our experience, Claritev has been very responsive with great turnaround times and the findings they’ve presented to SIHO have been accurate and reasonable.

    Claims Department

    SIHO Insurance Services, Inc.

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