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We work with all stakeholders in the health insurance industry.
At Taha, we work with all stakeholders in the health insurance industry, from large insured and self-insured groups to regulators, service providers (hospitals and clinics), as well as TPAs and insurance companies, while adhering to our obligations, professional and contractual, that require us to disclose or avoid conflict of interest.
These are examples of some of the problems our clients have encountered, the approaches we took to solve them and the eventual outcomes.
Insurance Programme Overhaul
Problem
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Our client was concerned about a worrisome trend in their yearly loss ratio, as claim amounts were increasing year over year. They were looking for ways to optimize their portfolio without having to increase the premium by a significant amount.
Cost-Drivers Analysis and Implementation
Problem
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Sometimes our services are rendered not as a limited-duration project, but rather as a continuous monitoring and oversight service. This was the case for a client who was running two health insurance programmes, where one programme was stable while the other was spiralling out-of-control.
Audit Support
Problem
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The client needed our support in performing financial and regulatory audits to compute recoveries to be paid by the TPA and/or medical providers. The claims-data spanned several years and was in the order of tens of millions of records, which meant that traditional analysis tools, like Microsoft Excel, were not the best fit for performing such sophisticated analysis. The audit team consisted of healthcare professionals with limited expertise in big data-processing.