Medical Billing Fraud Detection
Medical Billing Fraud Detection
Undisclosed/NDA
Undisclosed/NDA
Overview
A prominent Healthcare Insurance Company needed Medical Billing Fraud Detection Software designed to help predict monetary risk from dental care providers based on comparison to their peers. The app was to be created through collaboration with a group of Data Scientists while leveraging machine learning methodologies and predictive AI models.
Overview
A prominent Healthcare Insurance Company needed Medical Billing Fraud Detection Software designed to help predict monetary risk from dental care providers based on comparison to their peers. The app was to be created through collaboration with a group of Data Scientists while leveraging machine learning methodologies and predictive AI models.
Problem
NEEDS:
The dental industry faces a significant challenge in identifying and preventing FWA (Fraud Waste and Abuse) risks among medical professionals, which can lead to compromised patient care and financial losses. There is a need for a comprehensive solution to address this problem.
Create an intuitive and user-friendly mobile application for dental professionals to report and track FWA cases. Tasks were not limited to:
Advanced Data - Implementing advanced data analytics to identify potential FWA risks.
Security - Design a secure system to protect the anonymity of whistleblowers.
Collaboration - Foster collaboration between dental professionals and client (dental insurance company), and regulatory bodies to prevent FWA.
Solution
AS PRODUCT DESIGN LEAD, I DELIVERED:
Web & Tablet App Design
Effective Onboarding Dashboard
UI Component Library
Process
V1 (MVP)
Conclusion
This Medical Billing Fraud Detection software, a white-labeled solution was designed specifically for the dental insurance industry, and has undeniably emerged as a formidable force in combating fraud, waste, and abuse amongst medical professionals. Its success in addressing these critical issues has not only been evident but also widely acknowledged. The web app has proven to be an indispensable tool in upholding the integrity of healthcare services, offering robust defense against illicit activities while ensuring that patients receive the quality care they deserve. Its utilization stands as a testament to its effectiveness, demonstrating a commitment to safeguarding the dental healthcare sector. Furthermore, the app's continued impact on fraud prevention and healthcare quality assurance remains pivotal, promoting a future where unethical practices are minimized.
Final Prototype
View Prototype ->
Problem
NEEDS:
The dental industry faces a significant challenge in identifying and preventing FWA (Fraud Waste and Abuse) risks among medical professionals, which can lead to compromised patient care and financial losses. There is a need for a comprehensive solution to address this problem.
Create an intuitive and user-friendly mobile application for dental professionals to report and track FWA cases. Tasks were not limited to:
Advanced Data - Implementing advanced data analytics to identify potential FWA risks.
Security - Design a secure system to protect the anonymity of whistleblowers.
Collaboration - Foster collaboration between dental professionals and client (dental insurance company), and regulatory bodies to prevent FWA.
Solution
AS PRODUCT DESIGN LEAD, I DELIVERED:
Web & Tablet App Design
Effective Onboarding Dashboard
UI Component Library
Process
V1 (MVP)