Navigate today’s most pressing health industry challenges with a leading global expert by your side.
Meet growing needs for innovative insurance solutions while increasing operational health and improving compliance.
Deliver on the promises of the past and create smart solutions for the future.
This is a place where your ideas and insights make an impact. Where an independent, entrepreneurial spirit is an advantage. And where diversity of thought and experience makes us who we are.
Data-driven insight. Deep expertise. Transformative innovation. Since 1947, Milliman has delivered intelligent solutions to improve health and financial security.
Reduce errors and improve cost savings with standardized, consistent claims processing tools.
Milliman Health ClaimsRef
Claims processors face time limits on claim settlement, making it challenging to perform detailed analysis. Rapidly evolving medical practices and non-standardized claim codes further complicate their work. Without tested and proven data structures and a unified team approach, excessive and unwarranted billing practices go unchecked.
Milliman Health ClaimsRef provides comprehensive, regionally appropriate reference guidelines to review billed services on health claims. It also offers business rules that can easily be integrated with claim systems to automate reviews.
Use a standard system of checks to avoid errors and omissions. Quickly identify unwarranted or excessive services.
Add value for clients with your reinsurance support. Enable efficient and consistent practices for your clients.
Simplify and streamline digital practices in your region to support benchmarking and future analysis for clients. Our rules also help ease the integration process and avoid delays.
Preauthorize claims with automated checks and reduce unwarranted use of expensive clinical resources. Settle clean claims quickly without time-consuming negotiations.
Promote standardization and uniformity in your business practice with tools that are easy to implement. Support training of claims team members with built-in tools.
Flag potentially incomplete, excessive, or fraudulent claims for manual intervention by applying our guidelines and rules upon receipt of claims.
Access hundreds of guidelines for common and high cost inpatient medical and surgical conditions from any device, wherever needed.
Use rules based on in-depth clinical experience, specific to your region, and designed especially for the claims adjudication process. The solution is supported by published research and market validation.
Rely on the experience of a clinical team of doctors and actuaries with global experience and awareness of regional practices and codes. Adapt and configure rules to specific insurance products and local coding systems.
Expect seamlessly integrated updates and enhancements from Milliman to keep current with trends in your region.
With an urgent need to bring cost inflation into a sustainable range, we examine best practices in reducing spending, while maintaining or improving patient outcomes.
With the ongoing COVID-19 pandemic, it has become all the more important for insurers to manage their claims and expenses.
Sophisticated population health analytics enable insurers to make smarter and more informed decisions on financial trend drivers, and can help medical management departments by more effectively allocating disease and care…
Whether you are overcoming current challenges, or looking to optimize operations to better compete tomorrow, we can help. Milliman offers complete operational consulting services including due diligence, turnaround practices, and performance improvement plans.
Milliman combines leading technology with decades of real-world expertise to help you find meaning in the numbers.
For companies entering the Indian health insurance market, we provide support for the full range of business needs, including regulatory filings, claims and underwriting strategy and manuals, product design and pricing, training and capacity building, reinsurance program design, provider contracting strategy, and technology selection.
Ask the tough questions. We’re ready for them.