top of page

Move from a
Rule Engine to an Analytical Engine

Integrate human insights and machine intelligence into claims decisioning

Group 12884.png
bg-service50.png

How it Works?

Construct Provider & Practitioner Profiles, Rules & ML Models, APIs & Social Media to reduce Fraud, Waste and Abuse in Claims Handling. 

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

Rectangle 503.png
Group 12884.png
Group 12886.png
Group 12885.png
Group 12905.png
Rectangle 503.png
Group 12809.png
Group 12807.png
Group 12828.png
Group 12829.png

Composable Business Process

Flexibility in authoring and executing processes suited for Investigation teams to detect Fraud, Waste & Abuse in Claims. Business processes can interact & interface with data vendors/ APIs, Social Media, Policy Management Systems and manage Communication across channels.

Modern Architecture

 A fully composable, modern architecture empowers you to rapidly address new and emerging use cases through common functionality. Partner across IT, business, product, security and data science with the ability to meet functional and non-functional requirements.

Rectangle 503.png
Group 12834.png
Group 12836.png
Group 12837.png
Group 12835.png

Problem Statement

Group 12825.png
Collaboration

Facilitate secure collaboration within the platform for risk assessment, investigation, and mitigation planning. This includes file sharing, annotations & audit trail.

Group 12827.png
Audit Trails

Maintain a comprehensive record of all communication activities, including timestamps, sender/receiver information, and content. This is crucial for regulatory compliance and forensic investigations

Group 12826.png
Channel Management

Omni channel support is key to engaging with today's customers: CRM, IVR, Email, Whatsapp, SMS and App based notifications are all part of the options.

Rectangle 503.png
Group 12897.png
Group 12896.png
Group 12899.png
Group 12898.png

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.

Rectangle 503.png
Group 12903.png
Group 12900.png
Group 12901.png
Group 12902.png
Rectangle 503.png
Group 12893.png
Group 12841.png
Group 12894.png
Group 12895.png

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.

bottom of page