In addition to tremendous cost pressures from healthcare payers, insurance companies are struggling to realize ROI from their clinical programs and challenged to justify investment in proactive measures for health and wellness. Our client, a large group health plan, faced these issues: corporate mandate to cut medical management costs, inconsistent nurse productivity rates, staffing for case management operations and rising clinical labor costs adding to already escalating operational costs. Our Global Clinical Services team deployed more than 150 registered nurses as a turnkey solution for the Utilization Management continuum, including Intake, Nurse Review and Peer Review Preparation. These were experienced US-accredited RNs operating from URAC certified facilities in the Philippines, with deep domain expertise in case management. As a result, we were able to reduce operating costs by more than 40%, while increasing turn around time compliance to more than 99%

A leading auto insurer was experiencing a higher than industry average incidence of fraudulent claims. The aim of our engagement was to enhance their upstream fraud detection capabilities not only at the claims-level, but also at the customer-level. Our team built a predictive model to identify fraudulent claims based on data related to type of policy, claims history, premium and a varierty of other datapoints. Cognizant used logistic regression to identify the factors characteristic of fraudulent claims and narrow down from an initial 97 to 7 critical parameters. As a result of our intervention, there was a significant reduction in false positives and the customer saved millions by managing the fraud detection process better and more efficiently.

Time-to-market is critical in the pharmaceutical industry – where lead times for new drugs can be up to 12 years. Our client, a large global pharmaceutical company, needed to focus on core activities, reduce cost of data operations and standardize processes across the globe. Through better reporting and process management, Cognizant helped free up resources to focus on new products and increasing the drug development pipeline. Our clinical trials services drove process and staffing efficiencies in the client’s clinical trial operation and reduced overall costs by 30 - 40%. In addition, over a period of five years, Cognizant provided productivity gains of 30 percent.