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  Healthcare Product Suite

  Know Your Member – (KYM)

Effectively prevent recipient-fraud with world-class member profiling

Know Your Member (KYM) provides top-class beneficiary profiling and helps Healthcare Payer(s) prevent the entry of ineligible beneficiaries. KYM gives a comprehensive picture of the beneficiary’s background including (but not limited to) any past or ongoing law-suits, prisoner records, capital gains, dual benefits, inheritance and exceptions, thus assisting the Healthcare payers in 360 degree scanning of the case and in making effective decisions on beneficiary inclusion.

 

Based on S.E.T. Universal Platform, KYM comes with generational features that makes complex processes such as Medicaid application review, a lot more contextual and simpler. Features such as Social Share and Collaboration enables the users to connect with experts while the risk investigation and scoring ensures that users form quick and constructive opinion about the case by identifying and analyzing the patterns and the corresponding possible fraudulent inclinations of the case-under-consideration.

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   Some Of Its Features

Smart Case Management

 

Allows the supervisor to consider 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.

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Social Share

 

Enables users /analysts to securely and instantaneously share a particular section / part of the page / the entire beneficiary’s application with colleagues to record their observation. 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 stakeholder

Intelligent Risk Scores

 

Earmarks beneficiaries / case at the first instance of any suspicion. The Risk-radial plot (first of its kindin any of the B2B application in the world) enables the users to quickly form a constructive opinion about the case through the risk ingredients, their contributions, etc. thus revealing the beneficiary’s specific susceptibilities.

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Interactive Dashboard

 

While providing a comprehensive summary of the all applications in terms of workload by age, risk event categorization and social activity, it allows the users to drill down to the last level of detail on a specific case’ attribute.

   Key Capabilities

Social collaboration

Social collaboration


Supports secure message exchange with Enrollment departments, and application sharing with related user accounts

Intelligent Risk Score

Intelligent Risk Score


Scores the beneficiaries for risk, based on their historic transactions, background checks and propensity to commit fraud

Beneficiary 360

Beneficiary 360


Find out beneficiary affiliations, relationships, historic details and much more

Social Share

Social Share


Secured sharing of cases with colleagues / experts with complete control on access privileges

Resolutions

Resolutions


Take action(s) on beneficiaries such as account suspension, letter generation seeking information, etc

Smart Reports

Smart Reports


Highly customizable reports enabling drill-down to the last level of information cascade

  Resources

KYB Brochure

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  Recommended Read

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