Healthcare Payer Fraud and Waste Reduction

Case Study on Healthcare Payer Fraud and Waste Reduction

presented by Michael Xiao and Kristin Meier of BCBS

Estimates of fraud, waste, and abuse in the US healthcare system range from 15-40% of the $3.5 trillion in annual healthcare spend¹. This is painful for insurers and consumers as the burden for healthcare costs increase.

We plan to discuss the new world of AI insurance operations and explore various anomaly detection methods using machine learning. We will illustrate ways of defining and framing problems so insights are actionable for business partners.  These methods save insurance firm billions of dollars annually by streamlining operations and reducing costs.