Predictive analytics

We use predictive analytics to detect and prevent fraud, waste and abuse.

Through predictive analytics, we help health care organisations fight fraud, reduce waste and mitigate risk.

OptumTM predictive analytics can help you identify patterns and trends indicative of fraud, waste and abuse, and develop algorithms to flag suspicious claims.

Fraud, waste and abuse costs the health care industry billions of dollars each year and impacts everyone in the value chain. 

Our predictive analytics model contains more than 140 algorithms for proactive fraud detection and leverages a customisable, rules-based engine to identify inappropriate claims across all stages of claims management.

Benefits attainable both pre- and post-payment

By regularly screening claims and monitoring irregular activity, we help health care organisations assert consistent, effective control over health care quality, cost and risk. The proactive nature of predictive analytics helps minimise loss, improve cash flow and optimise return on investment.

Optum predictive analytics may be applied prepayment to prevent erroneous payment or post-payment to flag claims for recovery.

By partnering with Optum, you may:

  • Report fraudulent activities to regulatory agencies and predict recovery propensity in a timely manner
  • Improve your overall audit adjudication process
  • Plan and realign future courses of action

Contact us today to learn how Optum can help you prevent fraud, waste and abuse through predictive analytics.