ScenAI

for Workers Compensation

The Workers Compensation business has addressable opportunities around Medical Spend, Indemnity Payment and Proactive Care. To exploit these opportunities, Insurers require real-time pivotal interventions in the form of alerts, automated decisions and augmented intelligence. ScenAI enables interventions to be delivered through Machine Learning, Data Science Models and Artificial Intelligence at scale, within the core claim system workflow. Indicative list of use cases in Workers Compensation when applied can provide you insights for pivotal interventions.

Medical Bill

Real-time decisions for approval and anomaly on Medical Bills helps address un-necessary Spend and increases Injured Worker Experience.

ICD Codes

Alerts, Automated decisions and Intelligence for Claim Handlers to scientifically decide the acceptance of ICD Codes and Body Part. This helps address leakage and improve Injured Worker Experience.

Comorbidities

Advanced Machine Learning and Natural Language Processing based flagging of Comorbidities, helps direct and deliver proactive care strategies.

Provider

Recommend right provider based on Injury and return to work data, helps with better Return to Work and assured support for the Injured Worker.

Litigation

Alert and Augmented insights on Litigation propensity within the workflow for handler to make better referral decisions.

Return to Work

Predict Return to Work (RTW) and alert deviation to happy path pattern based on Injury and Body Part, thereby helping care for Injured Worker.

Compensability

Alert, Automate and Augment Claim Compensability decisions within the workflow so that claim handler can focus on delivering value based activities.

Nurse Care Manager

Automate and Augment allocation and deallocation of Nurse Care Manager on a file, helps reduce unwanted resource spend and improves return to work for Injured Worker.