How SulAmerica Fights Insurance Fraud, Waste and Abuse

One of the biggest challenges in fraud detection today involves not credit but insurance claims. That’s one reason to celebrate this year’s winner of the 2015 FICO Decision Management Award for Fraud Control, SulAmerica.

SulAmerica, the largest independent insurance group in Brazil, where fraud, waste and abuse can occur in nearly 20 percent of insurance claims. After only a year in deployment, SulAmerica is realizing R$1.2 million per month in savings.

SulAmerica uses FICO® Insurance Fraud Manager, a solution that verifies that payments and claims are accurate, valid, and compliant with provider agreements. Insurance Fraud Manager is used within SulAmerica’s claim process to identify fraudulent claims, as well as waste through clerical or systemic error.

“The month-to-month improvement in savings through denied claims has been outstanding,” said Fabiano Carraro, Intelligence Health Claim Superintendent at SulAmerica. “This solution is a fantastic example of the longstanding partnership between FICO and SulAmerica. FICO provides the core analytic expertise, while the SulAmerica team provides the domain knowledge and rule development.”

”Fraud, waste and abuse in insurance is a huge problem,” said Michael Wu, chief scientist at Lithium Technologies and one of the 2015 Decision Management Award judges. “SulAmerica is breaking away from the whole ‘pay and chase’ scenario and using analytics to detect potential fraud prior to payment. The judges were impressed with its data-driven approach and the benefits it has achieved.”

Congratulations to SulAmerica!