Wipro and Opera Solutions Launch Solution to Detect and Address Fraud and Waste in US Healthcare Insurance Claims
JERSEY CITY, N.J. & EAST BRUNSWICK, N.J. & BANGALORE, India--(BUSINESS WIRE)--Jun 12, 2018--Wipro Limited (NYSE: WIT, BSE: 507685, NSE: WIPRO), a leading global information technology, consulting and business process services company, today announced the launch of an end-to-end solution to address the issue of fraud, waste, and abuse in healthcare insurance claims in the United States, in partnership with Opera Solutions, LLC. Opera Solutions LLC is a global leader in applied Big Data analytics and artificial intelligence (AI).
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The solution will combine Opera Solutions’ powerful AI and machine learning based Fraud, Waste and Abuse (FWA) detection engine with Wipro’s extensive full-service claim processing capabilities in claims review, which includes the forensic examination of questionable claims, audits, adjustments, negotiations, recovery follow-up and payment posting.
Opera Solutions’ FWA detection engine leverages proprietary entity risk scoring algorithms that significantly outperform traditional rules-based methods. While existing approaches primarily search for irregularities on a claim-by-claim basis, Opera Solutions’ detection engine goes far beyond claims to identify anomalous treatment patterns for every healthcare entity, i.e., all healthcare providers and physicians across major medical specialties. This approach will substantially improve the identification rate of high-risk claims and reduce the number of false positives, or flagged claims that are in fact, legitimate.
Wipro’s claims auditors can thus begin their work with a far more accurately prioritized list of claims to review, along with a detailed background and reason codes for flagged claims, thereby, enhancing their efficiency and reducing claims review turnaround time. It reduces the admission of non-allowable claims, as well as customer dissatisfaction arising out of the holdup of legitimate claims that were flagged, erroneously. This will help healthcare organizations focus on delivering high-quality care in the most efficient manner possible.
“As one of the global leaders in healthcare insurance claims services, we are aware of the many limitations of automated rules-based systems for first-line claims review,” said Nagendra Bandaru,Senior Vice President and Global Head - Business Process Services, Wipro Limited. “Opera Solutions’ powerful entity-based AI-powered approach, when combined with Wipro’s deep claims management expertise, will give us an edge in the market and enable us to create tremendous value for health insurers.”
Arnab Gupta, Chief Executive Officer and Founder of Opera Solutions, said, “Our strategic relationship with Wipro is a perfect example of the ways in which advanced pattern-based AI and machine learning can allow talented and highly experienced people to become even more effective at what they do. We look forward to working with Wipro to take this powerful new capability to the market.”
About Wipro Limited
Wipro Limited (NYSE: WIT, BSE: 507685, NSE: WIPRO) is a leading global information technology, consulting and business process services company. We harness the power of cognitive computing, hyper-automation, robotics, cloud, analytics and emerging technologies to help our clients adapt to the digital world and make them successful. A company recognized globally for its comprehensive portfolio of services, strong commitment to sustainability and good corporate citizenship, we have over 160,000 dedicated employees serving clients across six continents. Together, we discover ideas and connect the dots to build a better and a bold new future.
About Opera Solutions, LLC:
Opera Solutions provides software, science, and services that help companies scale analytics across the enterprise and achieve profits and growth that would otherwise not be possible. The company serves global leaders in financial services, healthcare, professional services, the public sector, telecom, retail, travel and leisure, and more through its offices in North America, Europe, and Asia. For more information, visit www.operasolutions.com.
Forward-looking and Cautionary Statements
Certain statements in this release concerning our future growth prospects are forward-looking statements, which involve a number of risks and uncertainties that could cause actual results to differ materially from those in such forward-looking statements. The risks and uncertainties relating to these statements include, but are not limited to, risks and uncertainties regarding fluctuations in our earnings, revenue and profits, our ability to generate and manage growth, intense competition in IT services, our ability to maintain our cost advantage, wage increases in India, our ability to attract and retain highly skilled professionals, time and cost overruns on fixed-price, fixed–time-frame contracts, client concentration, restrictions on immigration, our ability to manage our international operations, reduced demand for technology in our key focus areas, disruptions in telecommunication networks, our ability to successfully complete and integrate potential acquisitions, liability for damages on our service contracts, the success of the companies in which we make strategic investments, withdrawal of fiscal governmental incentives, political instability, war, legal restrictions on raising capital or acquiring companies outside India, unauthorized use of our intellectual property, and general economic conditions affecting our business and industry. Additional risks that could affect our future operating results are more fully described in our filings with the United States Securities and Exchange Commission. These filings are available at www.sec.gov. We may, from time to time, make additional written and oral forward-looking statements, including statements contained in the company’s filings with the Securities and Exchange Commission and our reports to shareholders. We do not undertake to update any forward-looking statement that may be made from time to time by us or on our behalf.
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CONTACT: Wipro Limited
Opera Solutions, LLC
KEYWORD: UNITED STATES ASIA PACIFIC NORTH AMERICA NEW JERSEY INDIA
INDUSTRY KEYWORD: TECHNOLOGY DATA MANAGEMENT INTERNET NETWORKS SOFTWARE HEALTH OTHER HEALTH PROFESSIONAL SERVICES CONSULTING INSURANCE
SOURCE: Wipro Limited
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PUB: 06/12/2018 08:28 AM/DISC: 06/12/2018 08:27 AM