The Social Paradigm of Claims Management
ثبت نشده
چکیده
Today’s claims management processes face challenges of inconsistent data, an ever-increasing number of channels and, perhaps most important, inflexible systems. By executing structured processes on an enterprise application and tapping supporting processes with the help of social software, claims management can be enhanced by reducing hidden costs, increasing operational efficiency and building a knowledge repository that informs continuous improvement to the end-to-end claims management process.
منابع مشابه
Policy, Theory, and Evaluation: Stop Mixing the Fruit Salad; Comment on “Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia”
The study of Health in All Policies (HiAP) is gaining momentum. Authors are increasingly turning to wide swathes of political and social theory to frame (Program) Theory Based (or Informed) Evaluation (TBE) approaches. TBE for HiAP is not only prudent, it adds a level of elegance and insight to the research toolbox. However, it is still necessary to organize theoretical thinking appropriately. ...
متن کاملThe Politics of Researching Global Health Politics; Comment on “Knowledge, Moral Claims and the Exercise of Power in Global Health”
In this comment, I build on Shiffman’s call for the global health community to more deeply investigate structural and productive power. I highlight two challenges we must grapple with as social scientists carrying out the types of investigation that Shiffman proposes: the politics of challenging the powerful; and the need to investigate types of expertise that have traditionally been thought o...
متن کاملImproving Fraud and Abuse Detection in General Physician Claims: A Data Mining Study
Background We aimed to identify the indicators of healthcare fraud and abuse in general physicians’ drug prescription claims, and to identify a subset of general physicians that were more likely to have committed fraud and abuse. Methods We applied data mining approach to a major health insurance organization dataset of private sector general physicians’ prescription claims. It involved 5 ste...
متن کاملپارادایمهای رقیب در علم سازمان و مـدیـریـت: رویـکـرد تـطبـیقـی به هستـیشنـاسی، شنـاختشنـاسی و روششناسی
The term paradigm hase penetrated in the web of many fields form natural to social sciences. Therefore, for each researcher, understanding it's Concept and dimensions is necessary. It is become to a common term in philsophy of science. There are many definitions of paradigm, but we can define it as: a set of believes and basic assumptions that are reflected in the ontology, epistemology and m...
متن کاملYour Call Could not be Completed as Dialled: Why Truth Does not Speak to Power In Global Health; Comment on “Knowledge, Moral Claims and the Exercise of Power in Global Health”
This article contends that legitimacy in the exercise of power comes from the consent of those subject to it. In global health, this implies that the participation of poor country citizens is required for the legitimacy of major actors and institutions. But a review of institutions and processes suggests that this participation is limited or absent. Particularly because of the complex political...
متن کامل