Posted Date: August 17, 2024 by:
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From Pay-and-Chase to Predict-and-Prevent: Modernizing Claims Fraud Detection

Client: A consortium of large and medium-sized health insurance companies called Alliance for Healthcare Payment Integrity (AHPI) seeking a unified, AI-enabled platform to process claims and detect fraud, waste, and abuse.

Overview of the Effort:

Centennial developed a next-generation healthcare payment integrity platform that could examine healthcare payment requests in real time and automatically route potentially fraudulent claims to case managers for investigation. Built with advanced analytics, AI-driven anomaly detection, and automation capabilities, the platform provided AHPI with an integrated solution to improve fraud detection, enhance compliance, and accelerate claims adjudication. Agile, SAFe, and DevSecOps methodologies were applied to enable continuous delivery and deployment, ensuring rapid iteration without compromising system security.

Challenges:

Insurers were hampered by fragmented systems, inconsistent fraud detection practices, and heavy reliance on retrospective “pay-and-chase” operations that drove up administrative and legal costs. The massive volume of claims, combined with diverse data formats and regulatory constraints, made it difficult to scale traditional detection methods. Insurers also needed the ability to securely share intelligence across entities while complying with HIPAA requirements.

Solution:

To address these challenges, Centennial engineered a secure, cloud-native platform that blended AI, automation, and scalable architecture:

  • Developed an intelligent claims integrity engine that analyzed 3M+ records per day, including 1M+ call records, with a database capacity of 128PB.
  • Designed AI/ML models to identify suspicious billing patterns and route flagged claims to case managers for investigation.
  • Integrated 28 core platform modules, 16 secure interfaces, and three UiPath instances with 32 robotic process automation (RPA) bots to streamline repetitive tasks.
  • Leveraged AWS cloud services for elasticity, fault tolerance, and cost optimization.
  • Implemented predictive analytics, adaptive sampling, and real-time dashboards to prioritize high-risk claims.
  • Adopted Agile, SAFe, and DevSecOps practices to enable continuous integration, automated testing, and secure deployments.
  • Ensured HIPAA-compliant data-sharing and audit trails across all 23 participating insurers.
Results:

The platform produced measurable and transformational results for participating insurers:

  • Processed 3M+ records daily, including 1M+ call records, across 23 insurance companies.
  • Identified and prevented hundreds of millions of dollars in improper claims payments, reducing fraud-related losses significantly.
  • Increased fraud detection accuracy by 45%, lowering false positives and investigation overhead.
  • Reduced average claims processing time by 30%, accelerating payments to providers.
  • Lowered administrative and legal costs by 42% by minimizing reliance on traditional pay-and-chase methods.
  • Achieved 99.99% platform availability and continuous delivery through Agile and DevSecOps pipelines.
  • Automated routine tasks with 32 RPA bots, improving staff productivity and efficiency.
Conclusion:

By deploying an AI-powered, cloud-native claims integrity platform, Centennial transformed the consortium’s ability to detect and prevent fraud, waste, and abuse. The solution reduced financial leakage, cut administrative costs, and delivered faster, more accurate claims processing, all while maintaining compliance with federal healthcare regulations. With its combination of advanced analytics, automation, and agile delivery, the platform established a new standard for collaborative healthcare fraud prevention.

About Centennial Technologies:

Centennial Technologies is a trusted provider of tailored solutions for government entities, prioritizing outstanding client service. Our diverse range of comprehensive Financial Management Solutions includes Financial Advisory, Reporting, Performance Management, Business Process Management, Financial Support, Benchmarking, and Risk Management. Our Information Technology (IT) Services offer expertise in Program Management Office (PMO), Application Development and Support, Cloud Solutions, Business Intelligence, Cyber Security, and Emerging Technologies. Renowned for our unwavering commitment to excellence, Centennial Technologies empowers government agencies and commercial clients to fulfill their objectives efficiently and effectively. Contact us directly for more information on how we can support your goals.

Contact Us today to get started.

Ben Marglin

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Vice President of Business Development

Ben Marglin is Vice President of Business Development at Centennial Technologies, focused on developing and leading the growth strategy for Centennial. With over 25 years of experience in public sector management and technology consulting, Ben’s strengths include building strong client relationships with both existing and prospective clients, and serving as a people leader across the organization, helping to promote a strong and healthy company culture. Ben leads the growth team to identify and capture new opportunities across the business development lifecycle, working to expand Centennial’s business in the Federal and commercial space. 

Before Centennial, Ben was a Senior Vice President at Karsun Solutions, where he led client delivery for a ~$130M portfolio across several Federal civilian agencies and led a team of over 500 folks providing support to Federal clients. He spent 17 years with Booz Allen Hamilton, mainly in Federal Civilian market leadership roles where he had full P&L responsibility for a portfolio of Federal agencies, and he also spent two years in BAH’s Strategic Innovation Group (SIG) helping to lead the Digital Solutions practice area. Earlier, Ben worked for American Management Systems (AMS) providing IT and management solutions to state and local clients, and he spent three years on Capitol Hill working in the U.S. Senate.

Ben’s areas of expertise include digital strategy and transformation, acquisition, change management, and IT program management. He has a master’s degree in public policy from Duke University and a bachelor’s degree from Colby College and has professional certifications in Program Management (PMP), AWS Cloud, Agile (SAFe and ICAgile), Change Management (CMAP), ITIL, and Technology Business Management (TBM). Ben lives in Northern Virginia with his wife, son, and goldendoodle Sophie, and when he’s not doing yard work, he enjoys golf, running and biking, and following his native Boston sports teams. You can connect with him on LinkedIn or Twitter.

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Sunitha Ravi

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Vice President of Operations and Delivery

Sunitha Ravi is the Vice President of Operations and Delivery at Centennial Technologies Inc. In her role, she focuses on building trusted relationships with senior federal clients while driving innovative and customer-centric solutions. Using over 26 years of experience supporting both the public and private sectors, Sunitha aligns technology with strategic business and operational goals while managing operations and technology teams to deliver excellent customer service.

Before Centennial, Sunitha was a Director at VMWare public sector and led various programs for federal clients through agile and scrum practices while meeting growth and profitability goals. Before VMWare, Sunitha held various leadership positions at Verizon, Terramark, and Tetra Tech. She managed the delivery of financial and technology solutions and served as a trusted advisor to executive and management stakeholders. She successfully led teams of over 200 staff and agency portfolios with ~$100M in annual revenue. She supported financial teams and improved the finance function by driving more efficient processes and streamlining financial reporting.

She holds a Master’s degree in environmental engineering and is an Earned Value Practitioner (EVP), Project Management Professional (PMP), and Information Technology Infrastructure Library (ITIL) certified. She lives in Ashburn, Virginia, with her husband and two daughters and enjoys traveling, spending time with friends and family, and cooking.

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Saishree Shetty

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Senior Director of Growth and Client Success

Saishree Shetty is the Senior Director of Growth and Client Success at Centennial Technologies. Saishree’s role is to expand our presence within the Civilian Health agencies, foster relationships with clients and potential partners, and enhance our current capabilities. She brings over two decades of experience in IT strategy, program management and delivery and business development in the federal and commercial sectors.

 

Before joining Centennial, Saishree was a Vice President of Business Development at a mid-size company and a woman-owned small business prior to that. She focused on growing accounts, increasing market presence, and capturing new business at various federal agencies. Having held several leadership positions in small and large consulting companies, Saishree brings a wealth of program management and delivery knowledge into her business development role.

 

Saishree has her Executive Leadership from Yale School of Management, Master of Science in Information Systems from Marshall University and a Bachelor of Engineering in Computer Science and Engineering. Outside of work, Saishree’s interests lie in outdoor activities, organizing social events and bringing people together. 

email us your CV at @centennial-tech.com - 17

Brad Marchand

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Executive Director of Growth and Client Success

Brad Marchand is the Executive Director of Growth and Client Success at Centennial Technologies Inc. In this role, he focuses on enhancing client relationships and expanding Centennial’s footprint across federal clients. With over 30 years of experience in digital modernization, enterprise systems implementation, and business optimization, Brad is dedicated to driving growth and delivering exceptional customer success strategies.

 

Previously, Brad served as a Partner at Grant Thornton’s Public Sector practice, where he led the Finance Transformation Service Line and ERP Practice. His leadership extended to SRA, Inc., where he played a key role in IT systems implementations for the federal government. Additionally, Brad brings private-sector expertise from his tenure at JPMorgan Chase as Vice President specializing in global supply chain implementations.

 

Brad holds a bachelor’s degree from DePauw University and is a certified Project Management Professional (PMP). A resident of Haymarket, Virginia, Brad enjoys golfing and supporting Chicago sports teams. He is also a proud parent who has coached his children in basketball and baseball.

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Shabiha Yasmin

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Senior Director of Delivery

Shabiha Yasmin serves as the Senior Director of Delivery at Centennial Technologies Inc., leveraging over 20 years of experience in the IT sector. With a process-oriented approach honed through extensive work with federal agencies such as CMS, FDA, EPA, and SSA, Shabiha excels in requirements elaboration, project definition, initialization, planning, and the successful delivery of complex technical projects. Known for her tenacity in securing stakeholder commitment to objectives, she excels in clarifying misaligned initiatives within strategic portfolios and resolving conflicts across cross-functional teams.

 

In her leadership role, Shabiha prioritizes exceeding client expectations by delivering innovative solutions, mentoring leaders, and staying abreast of emerging technologies.

 

Before joining Centennial, Shabiha served as a Program Manager at CareFirst, where she provided subject matter expertise in IT modernization, financial management, and business transformation initiatives. She focused on assembling robust and agile teams to support diverse federal agencies. Shabiha’s professional journey also includes holding leadership positions in technology divisions of esteemed organizations such as Northrop Grumman, Lockheed Martin, and CareFirst.

 

Shabiha holds a Bachelor of Business Administration with a major in Biochemistry and Botany, complemented by an MBA degree in IT and Marketing. She is a certified Project Management Professional (PMP), Certified Scrum Master (CSM), SAFE Agilist, and ITIL4 practitioner.

 

Shabiha resides in Clarksburg, Maryland, and is a proud parent of two children aged 20 and 13. Outside of work, she enjoys indulging her passions for rock music, attending concerts, embarking on hikes, exploring new destinations through travel, and engaging in various crafts.

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Prasad Siddabathuni

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Director of Technology

Prasad Siddabathuni is the Director of Technology at Centennial Technologies Inc. He provides invaluable technical and strategic leadership, solutions, and advisory services to our clients, partners, and internal teams.


With 25 years of experience in the technology domain, Prasad has a remarkable track record in delivering technical services and solutions across diverse IT sectors. He specializes in delivering integration, cloud, and data/AI strategies that drive enhanced process improvements and reduce costs. Prasad is adept at building and executing long-term product and service strategies across matrixed organizations, as well as in establishing and directing multinational technical and business teams. His proficiency areas include ownership and innovation, presales, architecture, transformation, delivery, M&A, integration, and field operations.


Prasad resides in Fairfax, Virginia, and enjoys traveling, playing the violin, and supporting local sports teams.

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Matthew Shields

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Director of Delivery and Customer Support

Matthew Shields is the Director of Delivery and Customer Support at Centennial Technologies Inc. He excels in building and leading high-performing teams across multiple concurrent contracts in fast-paced, high-profile environments. With a focus on cultivating professional relationships with clients, Matt brings over 25 years of experience in federal consulting, account management, program management, contract execution, and quality management to his role at Centennial.


Before joining Centennial, Matt served as a Senior Program Manager at Halvik Corp., where he provided expert contract management, budgeting, financial management, and program management services to an Agency-level portfolio. He oversaw the efforts of multiple project managers, prioritizing the achievement of program objectives and the delivery of high-quality results while maintaining disciplined financial management practices. Before his tenure at Halvik, Matt was a Director at Evoke Consulting, where he supported Operations and Business Development, spearheading enterprise-level transformational initiatives across various government agencies.


Matt earned his bachelor’s degree from Washington College and holds certifications as a Certified Scrum Master (CSM) and Project Management Professional (PMP). He is trained in Capability Maturity Model Integration (CMMI), ISO standards, and Organizational Change Management (OCM).


A lifelong resident of Loudoun County, Virginia, Matt is passionate about adventure travel, hiking, and cycling in his leisure time. He and his wife take pride in being parents to two Eagle Scouts and are actively involved in volunteering with their sons’ troop.

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Ned Blackburn

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Senior Director of Growth and Client Success

Ned Blackburn is the Senior Director of Growth and Client Success at Centennial Technologies Inc. In his role, he focuses on exceeding clients’ expectations through delivering innovative solutions, advising customers, and working with solution partners. Ned brings 25 years of experience in strategic account management, program management, and business development in the federal and commercial sectors to Centennial.

Before Centennial, Ned was a Director at Grant Thornton, providing subject matter expertise on IT modernization, financial management, and business transformation initiatives. He focused on building resilient and agile teams to support various federal agencies. Prior to Grant Thornton, Ned held several leadership positions in small and large businesses where he led business development, capture management, and vendor partnerships. He built and managed large teams specializing in Enterprise Resource Planning (ERP), Business Intelligence, and Data Warehousing solutions.

Ned earned his Bachelor of Business Administration from Ohio University, is a Project Management Professional (PMP), Certified Scrum Master (CSM), and ITIL4 certified. He lives in Ashburn, Virginia, with his wife and three children. He enjoys coaching little league baseball, playing golf, and cheering for Cleveland sports teams.

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Antonio "Tony" Hylton

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Chief Strategy Officer​

Antonio “Tony” Hylton is Chief Strategy Officer for federal and state sectors at Centennial Technologies Inc. In this role, he develops service offerings, establishes strategic partnerships, and supports acquisitions. Tony brings over 30 years of public and private sector experience with business transformation, organizational change management, and innovative solutions to Centennial.

Before Centennial, Tony held various leadership positions at Verizon and managed over $100 million per quarter in sales. He guided the relationships with the National Association of State CIOs, National Association of State Technology Directors, US Conference of Mayors, and numerous state, local, and public safety agencies. Before Verizon, Tony served as Chief Information Officer (CIO) of Cook County, IL, where he led budget planning and execution, process optimizations, and technology innovation. Before Cook County, Tony held a variety of leadership positions with the Center for Digital Government (CDG), Dell-EMC, AT&T, and MCI.

Tony earned his bachelor’s degree from Northeastern University, is an accomplished Lean Six Sigma Black Belt, and Certified Scrum Master. He loves golf and watersport activities. He is a home chef with a specialty in Asian-Fusion and Japanese Cuisines.

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Mani Allu

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Founder and Chief Executive Officer

Mani Allu is the Founder and Chief Executive Officer of Centennial Technologies Inc. With over 25 years of experience providing financial and technical solutions, Mani provides overall direction to the corporate growth strategies, differentiated capabilities, and company culture. He works directly with customers, employees, and partners daily and fosters the work environment to develop and deliver highly innovative solutions.

Before founding Centennial, Mani held leadership positions at Verizon, where he led operations and delivery of enterprise services for public and commercial sectors, supporting $240M in revenue. He focused on solutions that drove efficiency and effectiveness, including financial transformation, organizational development, business intelligence, data analytics, application and system modernization, cloud enablement, and cybersecurity. Before Verizon, Mani served as the Vice President at ADS Inc. and supported the telecommunications, financial, retail, and media sectors. He orchestrated the creation and management of service offerings, supervised partnerships, and supported mergers and acquisitions.

He earned his Master’s degree from West Virginia University and lives in Ashburn, Virginia, with his wife and kids. He enjoys tennis and supporting his home sports teams.