Recent technological developments and the ability to process large volumes of data in any format and give them a meaning beyond their individual parts make Big Data a major transformative factor in our solutions. Cegedim Insurance Solutions has long understood of Big Data's value, so it formed a special team and a programme of work dedicated solely to it.
What is big data?  Big Data lies at the heart of new professions and at the crux of business intelligence, statistics, actuarial skills and marketing.
A change in BI techniques, in terms of:


 

The volume of processed data

 

The processing speed

 

The diversity of data formats
and structures

 

A uniquely valuable final product

Which data sets should we use?

Large volumes of data
 
The range of available data is vast, thanks to the diversity of Cegedim Insurance Solutions' products; and it is also enriched by our positioning as a third-party payment cover operator, managed service provider, flow processor and benchmark manager (for the treatment range in particular).

Data is created with respect for contractual frameworks defined with each of our customers and in line with regulations.


WHAT WERE THE AIMS
OF OUR NEW PRODUCTS?



  • Enrich our tools for control management, detecting anomalies/fraud and awarding services
  • Examine insurers' actuarial calculation models, with attention to new inputs (usage data, lifestyle, patients' compliance to treatment, etc., in addition to information about claims)
  • Better target and profile insured customers by studying weak signals and implementing predictive and personalised monitoring

Detecting anomalous behaviour

Cegedim Insurance Solutions has developed a service for detecting anomalous behaviour. It is based in various different professional skills:

  • Implementing control baselines and benchmarks using our managers' expertise and the sheer volume of data we manage. Modelling for verified anomalies
  • A tool for predictive analysis and anomaly detection
  • Recoveries and alerts for each portfolio and segment, as standard and upon request
  • Advice about action and prevention: upstream controls
    guarantee reviews, etc.


You process the results and implement corrective action:

  • In-depth investigations into cases flagged-up as suspect
  • Notification of customer debts where fraud has been confirmed
  • Guarantee reviews with potential alterations to coverage and introduction of limits to guarantee proper usage
  • Implementation of filters and reinforced controls

 
Detecting anomalous behaviour


 
This product lets users move away from an empirical approach towards an automatic risk management system. This is possible thanks to synergies of expertise between Cegedim Insurance Solutions and its customers.
            

Key benefits

Reduced expenditure

Stops on wrongful payments and debt recovery
Risk analysis and control (treatment providers
and consumers, health cover)

Prevention of risks linked to guarantees

Anticipation and prevention: deauthorisation, adjustment of guarantees, limit integration, reinforcing and checking the
relevance of controls throughout the entire payment process

Predictive behaviour analysis

Reducing anomalous behaviour through health professionals
and insured customers' improved understanding of controls

Reinforcing an insurer's image

Managing expenditure, impacts on product pricing,
development of advantageous partnerships, opening new services

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