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Milliman’s ClaimsRef clinical rules embedded in Munich Re HealthTech’s SHIELD system, enabling new efficiencies for insurers


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    New initiative brings together Milliman’s clinical logic and Munich Re HealthTech’s SHIELD system

    Milliman, Inc., a premier global consulting and actuarial firm, today announced a strategic alliance with MR HealthTech Ltd., a division of Munich Re. Milliman’s ClaimsRef clinical rules will be embedded into Munich Re HealthTech’s SHIELD innovative system that automates claims medical adjudication, detects potential fraud, waste and abuse, and justifies denials. The combined offering provides health insurers and government healthcare payers in the Europe, Middle East, Africa and Asia with a rules-based solution to manage health claims more accurately and efficiently..

    “Health insurers are seeking ways to better validate clinical data and allow a sharper understanding of populations and cost,” said Milliman Global Health Practice Director Thomas D. Snook. “Milliman’s ClaimsRef clinical rules help health payers achieve these objectives through standardization, rules-based automation, and streamlined processing.”

    Munich Re HealthTech is a leading global specialist in digital solutions for the health insurance industry. Driven by innovation and a quarter-century of expertise, Munich Re HealthTech offers SHIELD, which combines rules-based and machine learning models to optimize insurers’ health claims outcomes.

    “This new integration brings together Milliman’s considerable clinical acumen and Munich Re HealthTech’s scalable platform, making it the premier option for insurers looking to shorten transaction times and achieve cost containment in their claims’ operations,” said Gerry Raftopoulos, CEO of Munich Re HealthTech.