INNOVATIONS TO OPTIMIZING THE HEALTH PLAN CLAIMS PROCESS, MITIGATE FRAUD AND MAXIMIZING COST EFFICIENCY
This event offers strategies and tools for health plans to successfully overcome the challenges of ensuring claims accuracy, improving provider and patient/member engagement and communication, utilizing actionable data and analytics to increase cost savings and mitigating claims fraud, and optimize the claims and service operations process.

Hear carefully curated presentations from key health plans that have developed and deployed effective processes to address key areas in:

* FRAUD PREVENTION

* OPTIMIZING METRICS & DATA

* PAYER/MEMBER ENGAGEMENT

* TECHNOLOGY INNOVATIONS

* PAYER/PROVIDER COLLABORATION

* PARTNERSHIPS (VENDOR/SOLUTION PROVIDER)

* OPERATIONAL INNOVATIONS

You will leave with best practices/proven strategies to:
  • Effectively work with providers to improve coding inaccuracies
  • Strategically predict, and measure outcomes
  • Improve provider engagement and the claims automation process
  • Streamline coordination of benefits, provide accurate data and implement key process efficiencies
  • Leverage analytics to mitigate fraud
  • Build a Payer/Vendor Partnerships that works
  • Develop analytical capabilities to drive claims auto-adjudication
Hear from a stellar faculty including CIGNA speaking on how they deployed data analytics for fraud mitigation.
Our Speakers:
Kaiser Permanente

Raul Matas

Director of Strategy, California Operations
Medwise Insurance Advocacy

Adria Gross

CEO
WellCare Health Plans

Tom Everette

Senior Director of Claims Audit
CareFirst BlueCross BlueShield

Mark Belford

Director, Large Group Operations
CAQH

Morgan Tackett

Senior Product Manager
Special Investigations Unit, Cigna

Jason DiNovi

Informatics Senior Specialist
Anthem

Sherry L. Murray

Director, Enterprise Coordination of Benefits Department
Digitech Systems, LLC

Christina Robbins

Marketing Manager
Falkenberg Fieweger & Ives LLP

Kirstin B. Ives

Partner
Coding & Compliance Experts

Michelle Ann Richards

Owner
Clover Health Plan

Brian Witherow

Product Operations
Clover Health Plan

Heather Cozzens

Claims Manager
United HealthCare (UHC)

Rich Dowell

Director - Network Service Enablement
Special Investigations Unit, Cigna

Douglas Rahden, MPH, CPMA

Core Analytics Team Lead
Testimonials
Who Should Attend:

FROM HEALTH PLANS & TPAs
VPs, DIRECTORS & MANAGERS OF:

  • Claims, Provider Relations
  • Service Operations
  • QA
  • Compliance
  • Member Services
  • Fraud Prevention
  • Utilization Review
  • Data Analysis
  • Reimbursement
  • Network Management
  • Provider Connectivity & Systems
  • Operations

Also of Interest to Attorneys, Consultants and Solution Providers Specializing in:

  • Healthcare Fraud
  • Claims Management
  • Claims Processing
  • Data Analytics
  • Subrogation
Our Partners
  • This event offers strategies and tools for health plans to successfully overcome the challenges of ensuring claims accuracy
  • This event offers strategies and tools for health plans to successfully overcome the challenges of ensuring claims accuracy