2025

Revolutionizing Healthcare with AI and Big Data

Entrant

AMITHAB MOHAN KRISHNA

Category

Technology Solutions - Big Data Solution

Client's Name

All Providers and Members in US

Country / Region

United States

Revolutionizing Provider Systems with AI and Big Data in Health care IT



The Integrated Provider solutions serve as a comprehensive, enterprise-wide platform designed to efficiently manage provider-related data and streamline interactions across markets and regions for Health Care industry. With a flexible data model and state-of-the-art technologies, the Provider Data solutions integrate AI and cloud solutions to enhance data quality, operational efficiency, and provider interactions.



Key Achievements:



AI-Driven Data Quality Improvements up to 95%: Implemented AI-powered data cleansing processes that significantly enhance provider data accuracy, improving decision-making and streamlining operations.



Enhanced Operational Efficiency: Optimized data-driven operations through real-time processing and AI-driven insights, resulting in faster processing times (6 days of claims process timeline to 1 day) and improved application efficiency to near real time.



Predictive Maintenance and Anomaly Detection: Leveraged AI to perform predictive maintenance and continuously monitor system operations, preventing disruptions by early detection of anomalies.



Improved Claims Processing and Member Services: Increased auto-adjudication rates with AI solutions, significantly reducing claims settlement times and enhancing provider and member satisfaction, especially during the COVID-19 pandemic.



Business Intelligence and Advanced Reporting: Utilized advanced BI tools for comprehensive reporting and analytics, offering stakeholders detailed insights into provider performance and cost management.



AI-Powered Virtual Assistants: Developed virtual assistants to facilitate user interactions, enhancing system navigation and efficiency in managing complex data landscapes.



Regulatory Compliance Automation: Implemented AI compliance tools to dynamically track and adapt to healthcare regulations, ensuring consistent adherence to industry standards and reducing non-compliance risks.



Through the integration of AI and business intelligence, the Provider systems has become an adaptive, efficient, and informed platform, significantly bolstering healthcare service delivery and supporting the strategic objectives of Health care Industry.

Credits

Solutions Engineer Advisor Sr/Elevance health Inc
AMITHAB MOHAN KRISHNA
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