When health claims are in question, EOH offers the following services:
- Data integration or capturing of all claims information utilising call centre processes and infrastructure.
- Application of predictive analytics to segment high risk claims for further investigation – i.e. relationship mapping and checking against fraud database.
- Use of layer voice analysis to confirm fraud / corruption hypothesis for proper planning and action by assessors.
- Enabling underwriters to finalise valid claims within required time frames – dependant on provider specific requirements.
- Desktop and on-the-road assessment, examination and verification processes to ensure proper action is taken against unscrupulous fraudsters.
- Objective medical opinions by expert medical practitioners.
The above processes include the application and policy assessment and verification, interviews with all direct / indirect parties involved, ombud / regulator enquiries management as well as record keeping of all involved in the criminal schemes.