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Move from a
Rule Engine to an Analytical Engine

Integrate human insights and machine intelligence into claims decisioning

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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

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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.

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Problem Statement

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Collaboration

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

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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

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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.

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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.

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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.

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