Summary
Healthcare organizations must detect and prevent fraudulent claims with data integration, analytics and audit solutions that meet HIPAA compliance standards. To maximize claim management efficiency, Qlik’s AI-powered fraud detection solutions identify financial exposure from claim inaccuracies, investigate flagged claims and anticipate future risks.
Access the podcast to hear healthcare experts discuss how Qlik Predict, Qlik Answers and Qlik Analytics optimize audit processes to identify attack trends and correct claim inaccuracies. Learn how healthcare teams enhance operational efficiency and performance tracking with actionable strategies that identify risks and validate billing policies.
Fill out the form to access the full podcast and discover how Qlik improves healthcare claims management with proactive fraud detection capabilities.
Speakers
Program Manager
ASHLIN Management Group
Mr. Berger is an experienced project portfolio and certified Project Management Professional (PMP庐) with ten years of experience in program/project planning, execution, and evaluation across diverse industries. He is skilled in developing and implementing an organization's vision, cultivating relationships, Qlik solution deployments, eLearning solution implementation, and building productive teams. Motivated to exceed organizational goals by developing people, creating efficient processes, and designing systems to measure and track progress. An effective leader with a proven ability to supervise and lead high-performance teams to ensure a 100% success rate in achieving goals in an extremely competitive business environment. His communication skills expertly convey messages to clients and team members and his leadership skills define the road map to complete the project successfully. Mr. Berger is a skilled trainer and motivator in marketing and working with the business community. He can assess and define application problems by conferring with clients and evaluating procedures and processes. He prepares and evaluates alternative workflow solutions and controls by establishing specifications and coordinating production with programmers. Mr. Berger oversees operations to deliver efficient and high-quality solutions and services to clients.
Clinical Consultant
Case & Life Care Management Consulting, LLC
Patty has worked in the healthcare and clinical industry for over 40+ years providing expertise to both providers and insurers in the fields of care management, utilization management, disease management, claims review and quality improvement with a focus on both commercial insurances as well as CMS Medicare and Medicaid. As a consultant, Patty continues to assist in the creation and implementation of Model of Care (MOC) Special Needs Plans and works as a consultant for NCQA in the review of both initial and off cycle MOC submission.
Patty has diverse leadership experience managing people and processes including director of utilization and care management.
In addition, Patty works as a nurse life care planner that focuses on review of clinical data, summarization of clinical information and cost analysis that is used to support the clients current and future care needs.
Sr. Clinical Consultant
Health and Management Consulting LLC
Anita provides expertise to health plans regarding a range of government program work such as quality improvement, the CMS Quality Bonus Program, Special Needs Plans (SNP) Model of Care (MOC), HEDIS, and Star Ratings improvement. She brings clients more than 40+ years of experience in the healthcare industry.
Anita has designed programs and initiatives to support preventive health and disease management business goals. She has a proven track record in developing various quality assurance programs, a public health online web-base, and written educational tools. Her diverse leadership expertise extends to managing people and leveraging team-building skills and situational leadership. She utilizes and values cross-functional relationships both internally and externally.
Anita has guided plans in readiness for CMS review of Models of Care, Various types of Accreditation Preparation, State or Government audits and Chronic Care Improvement Programs (CCIPs). She has also developed project management tools, readiness assessments, and corrective action plans.
Senior Data & Analytics Consultant
ASHLIN Management Group Inc
Tim Gafvert is a Senior Data & Analytics Consultant at ASHLIN Management Group Inc. With a background in data visualization, dashboard development, and analytics strategy, he has worked extensively with government agencies and non-profits to modernize their data practices. His expertise lies in Qlik Sense, predictive analytics, and AI-driven insights, helping organizations turn complex datasets into actionable intelligence. In his current role, he leads the development of custom analytics solutions that enhance decision-making, streamline operations, and maximize the value of organizational data.
