Case Study Highmark Healthcare Fraud Analytics

FICO health care fraud analytics uncover vast savings for Highmark

Highmark Inc., a leading Pennsylvania health insurer, is dedicated to identifying potential losses from fraud, abuse and errors in claims processing. But its dedication is not just in principle—it’s in action. By taking a leadership role in adopting advanced analytic scoring models, today Highmark has impressive numbers to show how much that dedication is paying off.

Working with FICO over the past five years, Highmark has taken advantage of two types of FICO analytic scoring models within FICO® Insurance Fraud Manager to improve its fraud and abuse detection. Highmark wanted to test the models’ effectiveness compared to its former use of rules and other approaches such as manual reviews and hotline tips.

“We’re extremely excited with the results of the FICO claims scoring models. The solution has already exceeded our expectations, and we expect to see even more value from it.”
— Denny Latsha Highmark

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