PRO BTP：用于实时检测可疑医疗费用索赔的分析工具
公司规模
Large Corporate
地区
- Europe
国家
- France
产品
- IBM Fraud and Abuse Management System
- IBM Counter Fraud industry solution
- IBM InfoSphere
- IBM SPSS Decision Management
- IBM WebSphere Application Server
技术栈
- IBM Operational Decision Manager
- IBM i2 Analyst’s Notebook
- IBM PureFlex System
实施规模
- Enterprise-wide Deployment
影响指标
- Cost Savings
- Customer Satisfaction
技术
- 分析与建模 - 预测分析
- 应用基础设施与中间件 - 数据交换与集成
适用功能
- 采购
用例
- 欺诈识别
服务
- 数据科学服务
- 系统集成
关于客户
PRO BTP 总部位于巴黎，是法国首家建筑和土木工程行业社会保障提供商。该集团为近 310 万会员提供支持，提供的产品和服务包括补充退休、非寿险和寿险、健康服务、储蓄、休闲和社交活动。
挑战
PRO BTP 是法国建筑和施工专业人士的社会保护组织。它为会员（员工、退休人员、工匠和建筑公司）提供养老金和医疗保险（公积金、健康和储蓄）方面的服务。该公司一直使用的处理系统仅在付款后才识别不合理的健康索赔。为了减少系统滥用和更好地控制费用，PRO BTP 需要在公司向医疗专业人员报销之前检测可疑索赔。
解决方案
IBM 与 PRO BTP 合作开发了一个安全的服务平台，专门用于检测、分类和打击欺诈、服务滥用和错误。借助经过专家验证的检测引擎，这个名为 Solon 的服务平台可以实时分析眼科和牙科报销索赔，以便公司在付款前或建立收费协议前对其进行评估。该平台具有丰富的预测模型，可用于帮助检测欺诈网络，它基于自学技术，汇集检测方案并利用观察站监视。
运营影响
数量效益
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