Healthcare

Medical fraud detection for a global insurance company

 

Client challenge

The client needed help flagging fraudulent medical insurance claims. The goal was to:

  • Determine logic to flag suspicious behavior and identify providers of interest
  • Leverage billing data to analyze suspicious providers

 

How we helped
  • We performed fuzzy matching to link multiple claim records to the same provider(s)
  • We used geocoding to create physical distance calculations between providers and between providers and claimants
  • We applied statistical methods (e.g., logistic ridge regression with sparse matrices, T-Score calculation, bootstrapping, etc.) to billing data to build propensity scoring models to rule claims as valid or invalid
  • Based on our modeling results, we created the fraud flagging logic to identify suspicious behavior and providers of interest
  • The team collaborated with the investigative unit, billing unit, and legal unit to create a provider fraud action plan

 

Fulcrum's data preparation procedures and predictive analytical models provided the quantitative basis for the provider fraud action plan.

Data-driven marketing strategy for a global eyewear company

 

Client challenge

A leading eyewear distributor was looking for analytical guidance to power their sales and marketing efforts and overcome challenges related to:

  • Cross brand affinity
  • Returns
  • Ideal price point
  • Customer lifetime value

 

How we helped
  • We provided deep analysis and customer relationship management consulting using advanced data modeling and analytics
  • We provided campaign management, campaign contact strategy, and campaign operations for multiple brands in the portfolio
  • Our Anvil™ platform hosted the CRM database and leveraged APIs with the client and its third party data sources

 

Fulcrum’s advanced data modeling and technology platform enabled a data-driven end-to-end sales and marketing operation.

Acquisition modeling for a global medical insurance company

 

Client challenge

A leading medical insurance company was seeking data driven campaign strategy, models, and marketing operations to accelerate their acquisition efforts.

 

How we helped
  • Our Anvil™ platform securely hosted the HIPAA-compliant marketing database, and managed APIs, householding, suppressions, NCOA updates, opt-outs, etc. 
  • We built predictive models to improve sales and marketing targeting and efficiency, including retention models for renewals. 
  • Through building and implementing response, attrition, and best customer look alike models we evaluated data sources while providing cross-channel campaign solutions.


Using Fulcrum’s Anvil platform we built, hosted, and maintained a HIPAA-compliant and model-driven marketing database for cross-channel campaign solutions.

Customer retention for a leading weight loss company

 

Client challenge

A well known weight loss service provider was seeking to:

  • Deepen analytical insights for maximizing campaign effectiveness
  • Analyze customer spending and attrition behavior 
  • Conduct campaign analysis and reporting metrics

 

How we helped
  • We developed a robust marketing database on Fulcrum’s Anvil™ platform to integrate data from multiple sources.
  • We provided analytical models for customer spending, attrition, lifetime value, and segmentation to inform marketing campaigns
  • We measured campaign success and refined future campaigns through a process of continuous improvement

 

Our team facilitated a data-driven direct-to-customer marketing operation with ongoing ROI measurement and a feedback loop of continuous improvement.

Customer communication and retention for blood glucose monitor company

 

Client challenge

A leading blood glucose monitor manufacturer sought to:

  • Modernize its communication streams 
  • Develop cross-channel communication coordination

 

How we helped
  • Our Anvil™ platform securely hosted the HIPAA-compliant marketing database and managed APIs. 
  • We built predictive models to improve customer retention and winback in the context of customer lifetime value.  
  • We provided ongoing cross-channel campaign experimental design and response analysis. 
  • We designed and carried out customer research to fine tune multi-channel communication messaging and strategy

 

Our data science team built comprehensive predictive models to execute upon cross-channel factors that retain customers while conducting deep market research to maximize relevant communication.