Built for Insurers
Move from a Rule Engine to an Analytical Engine supporting Profiles & ML
Reducing Fraud, Waste & Abuse
Drona offers an analytical engine with ability to detect new and emerging schemes to minimize fraud, waste and abuse in Policies. Build complex rules and ML models, Streamline the collection of evidence & improve investigations to deliver faster results
Tackle Fraud Rings leverage Social Media
Analyze Claims for overlap with identified Fraud cases, Wasteful practices, Providers, Practitioners etc. to identify fraud rings. Integrate Social media information to enhance fraud ring identification capabilities.
Benefits
Scalability
Leverage a scalable architecture to meet the growing needs of digital payments
Custom Rules
Tune models to your business goals, reduce fraud or manage delinquency
Investigations
Help investigators by providing data on a single pane of glass & support custom workflows
Provider & Practitioner Profiles
Build profiles for each provider, practitioner or location associated with claim quality, fraudulent claims, recent coding practices and also compare behavior between peer groups. Enhance claims decisioning based on Provider & Practitioner Profiles.
Robust Case Management
Drona brings together information related to a potential fraud, including related claims, pre-authorizations, history, notes and supporting documents. The Case Management is flexible and Customized with specific fields & views suited to your process.