Challenge: Most health plan claim adjudication software platforms use decision logic that is hard-coded into software. This makes it difficult for companies such as SEB to offer flexibility in plans and necessitates IT involvement to make any changes. Solution: By incorporating FICO® Decision Management Suite into its proprietary adjudication platform, SEB allows business users, who are the industry and customer experts, to change rules in the platform directly, without requiring a new IT development cycle. Results: SEB has created a flexible solution that can respond to the needs of the marketplace and individual customers, and it has opened up new possibilities for future service offerings.
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