Navigate today’s most pressing health industry challenges with a leading global expert by your side.
Discover intelligent digital solutions to help improve outcomes, manage costs, and solve the toughest healthcare challenges.
Meet growing needs for innovative insurance solutions while increasing operational health and improving compliance.
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Deliver on the promises of the past and create smart solutions for the future.
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Manage complex risks using data-driven insights, advanced approaches, and deep industry experience.
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This is a place where your ideas and insights make an impact. Where an independent, entrepreneurial spirit is an advantage. And where diversity of thought and experience makes us who we are.
Data-driven insight. Deep expertise. Transformative innovation. Since 1947, Milliman has delivered intelligent solutions to improve health and financial security.
Minimise errors, processing time and costs with rules-based technology-solution.
Milliman Health ClaimsRef
Waste and inefficiency cost insurers billions of dollars each year. Without proven data structures and well-defined processes, excessive and unwarranted services go unchecked. However, claims processors face time limits on claim settlement, making it challenging to perform detailed analysis. Rapidly evolving medical practices and non-standardized claim codes further complicate their work.
Combining clinical knowledge and decades of experience across a wide range of projects, Milliman Health ClaimsRef applies configurable business rules to manage health claims accurately and efficiently. Data and learning from multiple geographies ensure that the rules are both evidence-based and locally relevant across most jurisdictions. Milliman Health ClaimsRef is easy to integrate with existing claim systems and can be used to automate claims processing.
Easily implement a standard system of checks that reduces errors and omissions during claims adjudication. Quickly identify unexpected, unwarranted, or excessive services and reduce waste.
Offer your clients an efficient and consistent framework for claims processing.
Enrich your offerings by integrating our comprehensive set of claims processing rules. Fast, efficient deployment based on our in-depth experience and best practices supports rapid return on investment for your clients.
Preauthorize claims with automated checks and reduce unwarranted use of expensive clinical resources. Settle clean claims quickly without time-consuming negotiations.
Promote standardization and uniformity in your business practice with tools that are easy to implement. Support training of claims team members with built-in tools.
Flag potentially incomplete, excessive, or fraudulent claims for manual intervention by applying our guidelines and rules upon receipt of claims.
Use rules based on in-depth clinical experience, specific to your region, and designed especially for the claims adjudication process. The solution is supported by published research and market validation.
Access hundreds of guidelines for common and high cost inpatient medical and surgical conditions from any device and any location
Rely on the experience of a clinical team of doctors and actuaries with global experience and awareness of regional practices and codes. Adapt and configure rules to specific insurance products and local coding systems.
Seamlessly integrated updates and enhancements from Milliman keep the rules, and guidelines fresh and relevant to your region.
With an urgent need to bring cost inflation into a sustainable range, we examine best practices in reducing spending, while maintaining or improving patient outcomes.
With the ongoing COVID-19 pandemic, it has become all the more important for insurers to manage their claims and expenses.
Sophisticated population health analytics enable insurers to make smarter and more informed decisions on financial trend drivers, and can help medical management departments by more effectively allocating disease and care…
Whether you are overcoming current challenges, or looking to optimize operations to better compete tomorrow, we can help. Milliman offers complete operational consulting services including due diligence, turnaround practices, and performance improvement plans.
Milliman combines leading technology with decades of real-world expertise to help you find meaning in the numbers.
For companies entering the Indian health insurance market, we provide support for the full range of business needs, including regulatory filings, claims and underwriting strategy and manuals, product design and pricing, training and capacity building, reinsurance program design, provider contracting strategy, and technology selection.
Minimize errors, processing time, and costs with a rules-based technology-solution.
Ask the tough questions. We’re ready for them.