Roosevelt Innovations, LLC is a software company and subsidiary of Delta Dental, the nation’s leading dental insurance provider. Roosevelt Innovations offers end-to-end solutions with industry-leading claims processing capabilities that have saved $972 million in treatment costs for over 23 million members.

Reviewing insurance claims for signs of fraud, waste, and abuse (FWA) is a tedious and time-consuming process. To enhance the claims assessment process and optimize resource allocation, our Predictive Claims Scoring system uses machine learning techniques to provide business and data analysts a preliminary score representing the likelihood of a claim containing FWA.

Business analysts reviewing claims leverage our system to search for specific claim identification numbers. Users are directed to a webpage displaying the specific claim’s FWA likelihood score and the attributes of the claim that were most influential to the score. For a broader search, a full history of claims and their scores are listed underneath the search bar, providing quick and easy access to valuable information.

Our software provides data analysts with intuitive graphs that show patterns and trends in insurance claim scoring, seen on the right. Charts and graphs update as new claims with scores are entered into the system. Analysts track claim denials over time and between attribute groups, enabling them to make connections and inferences quickly and efficiently.

Identifying patterns in denied claims enhances the business analysts’ workflow and improves the overall effectiveness of the claims assessment process.

Our system’s website is written in HTML/CSS and uses FastAPI to interact with the Snowflake database. Dashboards within our software are built in Tableau. Our machine learning model uses the scikit-learn library in Python.