Prakash Upadhyayula - Plainfield IL, US Navaneeth Nair - Hamden CT, US Pramod Waingankar - Orange CT, US Paul Kniskern - Springfield MA, US Bob Lezon - Andover CT, US Soham Chakravarti - Middletown CT, US
Assignee:
Aetna Inc. - Hartford CT
International Classification:
G06Q 40/00
US Classification:
705 4
Abstract:
A system for real-time health care insurance underwriting is described comprising a quotation module, a verification module, and an underwriting module. The quotation module receives user input relating to a user's health status via an online user interface. The verification module verifies the user input against information stored in a database to form a list of inconsistencies and present the user via the online user interface with a request to validate at least some information within the user input. The underwriting module automatically creates a debit score based on one or more of at least a portion of the user input and the validated information and generates an underwriting decision based at least in part on the debit score. The quotation module presents one or more offers to sell insurance to the user via the online user interface, the one or more offers based on the underwriting decision.
System And Method For Decreasing Turnaround For Pre-Authorizations Using A Smart Request For Information Model
- Indianapolis IN, US Sharon M. Goist - Alamogordo NM, US Jordan S. Firfer - Buffalo Grove IL, US Jayant Chaudhuri - Suwanee GA, US Rakeshkumar Patel - Glastonbury CT, US Soham Chakravarti - Suwanee GA, US
Assignee:
Elevance Health, Inc. - Indianapolis IN
International Classification:
G06Q 40/08 G16H 40/20
Abstract:
A method for reducing pre-authorization turnaround time is disclosed. The method includes, at a database, receiving historical data including a historical pre-authorization request and clinical information associated with a historical pre-authorization request. The method further includes receiving real-time data using an API gateway including real-time pre-authorization requests wherein the real-time data includes the real-time pre-authorization procedure and a clinical document category. The method further includes removing irrelevant data from real-time data and historical data to produce clean historical data and clean real-time data. The method further includes extracting data features required to train a machine learning model from the clean historical data and clean real-time data. The method further includes training the machine learning model by applying the extracted data features from the clean historical data and clean real-time data. The method further includes identifying prediction data results by applying the trained machine learning model.
WellPoint since Jun 2010
Solutions Engineer Executive Advisor
Aetna Nov 2004 - Jun 2010
Sr. Application Tech Specialist
OST International Sep 2004 - Nov 2004
Sr Systems Analyst
Syntel May 2003 - Sep 2004
Sr. Programmer Analyst
Selectica Aug 2001 - May 2003
Consulting Engineer
Education:
University of Pune 1997 - 2001
Bachelor of Engineering, Electronics & Telecom
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