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Predict Profiler

Surveillance of High Dollar Diseases and High-Risk Individuals At-A-Glance

Predict Profiler is the definitive surveillance tool to detect hidden catastrophic claims. Predict Profiler delivers vital risk feedback for TPAs, MGUs, and Stop Loss carriers allowing for quick and simple identification of previously hidden claims that were buried underneath layers of file formats and code. It provides underwriters and case managers with a comprehensive risk profile, breaking down costs and illuminating potential issues with their book of business.

No more ambiguity or confusion, have the data you need sorted and filtered in minutes.

Improve Production Time by 50%

Get Unobstructed Views Of:

New Business

Profiler instantly provides detailed data on new clients that were sold with little to no medical background. On cases where the underwriter was unable to obtain up to 36 months of prior medical history, Profiler will begin to compile the data required to closely monitor a group that was rated blindly.


Lasers

In areas where the underwriter sets a “Conditional Laser” on potential risk(s), Profiler monitors diagnostic and incurred claims and accurately assists in predicting the large claims risk ahead.


For MGUs and Stop Loss Carriers who load a specific premium for no lasers, such as a 9% load with no new lasers imposed on next renewal, this tool is priceless. It is able to manage that 9% to ensure the premium increase covers the “no laser” agreement. Profiler is able to watch these claims to ensure they do not push the loss ratio in the wrong direction.


Rate Caps

For MGUs and Stop Loss Carriers who place a cap on the specific rate for renewal, such as 45%, Profiler allows the underwriter to monitor monthly claim reports to ensure that the current experience profile does not differ dramatically from the original data used to underwrite the case and approve the rate cap. Unexpected claims can be quickly identified and addressed with cost containment measures to retain a positive loss ratio.


Renewals

Profiler provides a single point of reference to gather massive data under one tool. Case managers and underwriters have actual data and real numbers (co-morbidities, cost comparison, PPO and Medicare discounts, demographics, provider/facility information, Group specific, claimant specific) at their fingertips which eliminates the “guess-estimates” that so many do when looking at paid claim’s and case management reports.


Analysis

The ability to sort and filter data to your specific needs makes your exported reports much easier to analyze. Profiler can weed out non-issue claimants, leaving only the riskiest ones. It can flag diagnoses which have the highest number of claimants, indicating that further investigation is warranted. Its quick 25% and 50% reports can drastically reduce the turnaround time needed for TPAs, Stop Loss Carriers, Reinsurers, and ASO Carriers to review, risk rate, and underwrite multiple groups.


Catastrophic Claims Analyzed in Minutes

Having the high-level data underwriters need to obtain at a glance is priceless. Predict Profiler provides a statistical overview of total/average claims spend and how it pertains to the risk for employer groups for easy and accurate underwriting. Users can view all trigger claimants by trigger diagnosis and trigger code, while also having the ability to view total spend by trigger diagnosis within the extract.


Predict Profiler gives users a multi-level view of the claims run:

Provides a statistical overview of the extract such as total/average claims spend

Analyzes the extract through the lens of PredictDx and PredictRx

The best part?

The robust and money-saving reporting of Predict Profiler is included in your PredictDx Membership!