Extracting the relevant information from health insurance claims data

In Germany and some other countries, health insurance companies have extensive and detailed information on the health of their customers. This information is a valuable basis for efficient claims and portfolio management. With AktuarCompress®, RISK-CONSULTING has developed an automated process for the compression and focusing of health claims data. The claims history of each insured person is compressed to the relevant information and thus enables a holistic view of the individual health history. The benchmark functionality integrated in AktuarCompress® also offers a comparison of the individual compression results with statistically expected values.

Furthermore, based on Predictive Modelling future health risks for the person can be identified that may not have been detected today. This enables the insurance company to take various approaches in operational management such as making offers on prevention and health measures that are tailored to the insured person or even suitable cross-selling offers. In 2016, RISK-CONSULTING was recognized by Google and Süddeutscher Zeitung for AktuarCompress® as a “Forward Thinker” in the digital lighthouse competition for innovative digitization projects in the insurance industry.

Advantages of using AktuarCompress®

  • Compression of the claims history of an insured person to the essential and relevant information
  • Recognizing and ignoring unimportant and implausible data
  • Significant process acceleration and increased efficiency in the in-force business management, e.g. through the automation of product changes and renewals
  • Clear and holistic presentation of the individual health situation of an insured person
  • Identification of insureds for tailored prevention and health management offers, thus positioning the insurer as a health partner
  • Improvement of the patient-centred care for the insureds
Nutzung von Leistungsdaten

Automation of renewals and product changes

Combining AktuarMed® and AktuarCompress®

In products with annual renewals, the insurer often takes the claims of the insured person into account when underwriting the policy renewal. The same applies when an insured person wishes to change from one insurance product to a different one with additional benefits. The determination of the state of health often takes place manually or only partially automated. The underwriters are obliged to search through extensive claims records and extract the relevant medical conditions. This is hardly manageable under the given conditions and is time-consuming and costly.

To solve this problem, RISK-CONSULTING has developed AktuarCompress®, a tool that automatically analyses the entire claims history of an insured person and identifies the relevant conditions. All diagnoses associated with a disease are summarised and represented by a case-related “leading” diagnosis. Unclear or inaccurate diagnoses are resolved in this process, unimportant and non-plausible or incorrect data is filtered out.

The combination of AktuarCompress® and RISK-CONSULTING’s evidence-based underwriting system AktuarMed® enables more than 90% of renewals and product changes to be automatically processed. Several major insurers in Germany have been successfully using the tool to automate product changes since 2016.

Automatisierung des Umstellungsgeschäftes