Advanced Analytics

Turning transactional data into

  • transactional
  • actionable


Our advanced analytics capabilities combine technical and clinical expertise to provide valuable insights that inform smart decisions. It gives us the ability to analyze claims data from many vantage points and understand what is happening in a claims population and why.

Analytical insights help pinpoint hidden cost drivers and identify emerging risks so claims professionals can focus on claims with the highest exposure potential. Analytics optimize program performance by guiding the development of strategies and tools that control utilization and spending on prescription drugs and ancillary medical services.

Analytical Talent

At the foundation of our sophisticated analytics program is an accomplished staff of data scientists and business intelligence experts. They draw on experience with Fortune 500 companies that include leading pharmaceutical manufacturers and healthcare firms to turn transactional data into actionable intelligence.

Data Visualization

Our data visualization initiative reduces complex analysis to easy-to-understand graphics displayed on the Vertic─ô dashboard. Clients gain a clear understanding of trends and risks in real time and can view high-level information across an entire claims population or segment details on individual claims. Alerts focus attention on the claims requiring immediate action to help claims professionals efficiently manage their time. The Healthesystems Risk Management Dashboard enables claims professionals to visualize a variety of risks as they emerge, including risk for opioid abuse, misuse and inappropriate prescribing.

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Predicting Risks

Our predictive modeling initiative integrates the SAS® data mining platform with our internal data warehouse to conduct complex analysis using hundreds of data points gleaned from claims data and other sources. It enables us to identify relationships between disparate events and circumstances in claims and understand why certain events and behaviors occur. With these new insights, we can accurately predict and alert clients to new claims that have a high likelihood for escalation without close oversight.