Solutions

Know Your Beneficiary

Effectively prevent recipient-fraud with world-class beneficiary profiling

Know Your Beneficiary (KYB), the latest addition to Digital Harbor’s “Know Your Risk” suite, provides top-class beneficiary profiling and helps Healthcare Payer(s) prevent the entry of ineligible beneficiaries. KYB equips the Payers with complete history of beneficiaries, their associations, transactions patterns, income & assets and intelligently earmarks the beneficiaries with risk scoring for fraud. KYB gives a comprehensive picture of the beneficiary’s background including any past or ongoing law-suits or charges, thus assists the Healthcare payers in making effective decisions on beneficiary inclusion. Based on S.E.T. Universal Platform, KYB enables instantaneous & secure collaboration with all relevant stakeholders, thus ensuring least time in making informed decisions.

Ensure the inclusion of genuine and deserving beneficiaries

  • Record, retrieve and share findings, thus leaving a trail of beneficiary’s activities and corresponding Payer actions
  • Intelligent risk scoring of beneficiaries on fraud
  • Instantly share, connect and chat with colleagues / experts to gain additional insight
  • Proactive alerts, at the first sign of suspicion, to prevent fraud
  • 360 degree information about beneficiaries in a highly customized dashboard

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Enables seamless collaboration among the users and all relevant stakeholders with S.E.T. Universal Platform

 

1. Social Share

Enables users / analysts to securely and instantaneously share a part or the entire page with colleagues / experts to record their findings

2. Social Collaboration

Allows case workers to add their comments, make attachments and record findings right at the attribute level which can be seen / referred by all relevant stakeholders

3. Smart Case Management

It allows the supervisor to look into the case analyst’ expertise, inclinations and current workload before assigning a case. Features such as linked applications, related messages & documents and recorded findings allow easy review of the case at any level in the work flow.

Key Capabilities

  • Social Collaboration Share comments, attachments and findings at attribute level
  • Intelligent Risk Score Scores the beneficiaries for risk, based on their historic transactions, background checks and propensity to commit fraud
  • Beneficiary 360 Find out beneficiary affiliations, relationships, historic details and much more
  • Social Share Secured sharing of cases with colleagues / experts with complete control on access privileges
  • Resolutions Take action(s) on beneficiaries such as account suspenion, letter generation seeking information, etc
  • Smart Reports Highly customizable reports enabling drill-down to the last level of information cascade