Our Solutions

Driving the revolution for LTC insurance.

Fuzion is focused on understanding policyholder and claims data to deliver solutions that drive bottom line results for carriers and improve the life of their policyholders.

We believe the claims process is far more than a series of transactions. We utilize proprietary, analytical software specifically developed for the long-term care insurance industry.

Through an understanding of how to extract meaning from data, we continually enhance the quality of our decision-making processes.

The ultimate goal of our solutions is to effectively improve a carriers’ operational and financial results.

Claims Management

For every dollar spent on claims, a very small percentage (~10%) is spent on administering the claim. Many carriers and third-party administrators spend a lot of process improvement effort making advancements on claims administration. Larger bottom-line impacts can be realized by placing focused efforts on improving the claims experience. Reducing the severity and instances of unnecessary or inappropriate claims payments will significantly benefit the carrier’s financial performance. Knowing how to utilize data to monitor key transactions and build meaningful claims management metrics is crucial to driving improved performance.

Claims Management

For every dollar spent on claims, a very small percentage (~10%) is spent on administering the claim. Many carriers and third-party administrators spend a lot of process improvement effort making advancements on claims administration. Larger bottom-line impacts can be realized by placing focused efforts on improving the claims experience. Reducing the severity and instances of unnecessary or inappropriate claims payments will significantly benefit the carrier’s financial performance. Knowing how to utilize data to monitor key transactions and build meaningful claims management metrics is crucial to driving improved performance.

Data Analytics

Fuzion has developed analytical platforms to drive both efficiency and understanding. These platforms were developed to keep a pulse on what’s happening throughout the business while also supporting detailed drill downs to identify what’s driving a certain outcome. The supporting data can be cleansed, organized, and presented in a way that supports all business functions from actuarial to legal and all roles from executive to operational analyst. The results, coupled with deep domain expertise, include readily available information, early identification of negative / positive trends, and the means to drive business improvement initiatives that provide the most value to the carrier.

Data Analytics

Fuzion has developed analytical platforms to drive both efficiency and understanding. These platforms were developed to keep a pulse on what’s happening throughout the business while also supporting detailed drill downs to identify what’s driving a certain outcome. The supporting data can be cleansed, organized, and presented in a way that supports all business functions from actuarial to legal and all roles from executive to operational analyst. The results, coupled with deep domain expertise, include readily available information, early identification of negative / positive trends, and the means to drive business improvement initiatives that provide the most value to the carrier.

Fraud Mitigation

Our best in class, comprehensive services aid clients in identifying and managing fraud, waste, and abuse (FWA).

The goal of this solution is to transform the culture of LTC insurance carriers and how fraud, waste, and abuse is managed and prevented to ultimately augment financials. Fuzion maximizes its fraud mitigation impact by combining fraud detection technology with comprehensive training, investigative programs, policy language review, and comprehensive risk review. More specifically, Fuzion utilizes a proprietary LTC insurance-specific platform that includes fraud identification, case management, and data drill-down visualization tools.

Fuzion’s fraud detection technology accelerates identifying fraud through the aggregating and analysis of disparate data sets, which ultimately helps prevent improper payments. Technology, analytics, and operational processes are strengthened by a comprehensive training program, where clients’ claims personnel receive training in early detection of FWA. With a focus on current trends, referral processes, case studies, and leading fraud indicators, continued training efforts bring fraud awareness to the forefront.

  • Fraud Detection Technology
  • Best Practices Implementation
  • Comprehensive Fraud Training
  • Reporting and Data Visualization
  • LTC-specific Fraud Platform
  • Investigation Management

Fraud Mitigation

Our best in class, comprehensive services aid clients in identifying and managing fraud, waste, and abuse (FWA).

The goal of this solution is to transform the culture of LTC insurance carriers and how fraud, waste, and abuse is managed and prevented to ultimately augment financials. Fuzion maximizes its fraud mitigation impact by combining fraud detection technology with comprehensive training, investigative programs, policy language review, and comprehensive risk review. More specifically, Fuzion utilizes a proprietary LTC insurance-specific platform that includes fraud identification, case management, and data drill-down visualization tools.

Fuzion’s fraud detection technology accelerates identifying fraud through the aggregating and analysis of disparate data sets, which ultimately helps prevent improper payments. Technology, analytics, and operational processes are strengthened by a comprehensive training program, where clients’ claims personnel receive training in early detection of FWA. With a focus on current trends, referral processes, case studies, and leading fraud indicators, continued training efforts bring fraud awareness to the forefront.

  • Fraud Detection Technology
  • Best Practices Implementation
  • Comprehensive Fraud Training
  • Reporting and Data Visualization
  • LTC-specific Fraud Platform
  • Investigation Management

Policyholder Engagement & Wellness

Providing seniors with tools to improve health and manage chronic diseases may not only increase their quality of life but may also decrease unnecessary long-term care claims. Fuzion is piloting policyholder engagement programs in the areas of transition care management and senior wellness. These programs may be extended to a carrier’s policyholders, eliminating the need for the carrier to perform program development, staff training and ongoing program maintenance and evolution. These exclusive programs personally engage policyholders by connecting them with need-specific resources and services. Effective transition care management can also dramatically impact claims payments over the life of the policyholder.

Policyholder Engagement & Wellness

Providing seniors with tools to improve health and manage chronic diseases may not only increase their quality of life but may also decrease unnecessary long-term care claims. Fuzion is piloting policyholder engagement programs in the areas of transition care management and senior wellness. These programs may be extended to a carrier’s policyholders, eliminating the need for the carrier to perform program development, staff training and ongoing program maintenance and evolution.  These exclusive programs personally engage policyholders by connecting them with need-specific resources and services.  Effective transition care management can also dramatically impact claims payments over the life of the policyholder.

Advocates for Wellness

With the expertise of a transition care management nurse, policyholders are identified and engaged to decrease the hours of care needed and/or to become fully independent and transition off claim. The transition care nurse also coordinates care with family members, caregivers, and providers. Policyholders who are on claim are encouraged to become advocates for their care and educated about safety, activities of daily living, and community resources to assist with regaining independence. In the senior wellness program, program advisors assess policyholder needs and provide referrals to appropriate local resources to promote and maintain policyholders’ independence.

Interested to Learn More?

With the depth of expertise necessary to develop industry best practices, Fuzion strives to improve the LTC insurance industry through better business decisions based on insight gained through innovative analytics. This mindset is present in everything we do. We hope you see something interesting and will contact us to learn more.