Decision Management & Optimization
LONDON — May 16, 2017
- Discovery Health in South Africa uses tools from FICO to automate decisions in certain processes within Discovery Health’s underwriting and claims processing.
- Discovery Health processes more than 100,000 transactions a day with FICO® Blaze Advisor® decision rules management system
- Discovery Health is South Africa’s largest administrator of medical schemes, providing administration and managed care services to more than 3.2 million beneficiaries
Silicon Valley analytics software company FICO (NYSE:FICO) today announced that Discovery Health in South Africa is using the FICO® Decision Management Suite to process as many as 100,000 transactions a day. As South Africa’s largest administrator of medical schemes with more than 3.2 million beneficiaries, Discovery Health uses FICO® Blaze Advisor® decision rules management system to assist in various processes, from insurance applications to claims processing, in order to accelerate decisions, save costs and improve the customer experience.
Using FICO Blaze Advisor, part of the FICO® Decision Management Suite, Discovery Health can instantly and automatically determine the eligibility of an insurance applicant and their dependents, set terms such as the waiting periods to be imposed and determine offers and requirements for acceptance (e.g., medical evidence, referrals to specialists). Underwriters and other staff can update decision strategies quickly, without the need for IT assistance.
Discovery Health has been using the FICO system since 2012, when it selected FICO Blaze Advisor to replace its previous rules management system and consolidate underwriting decision-making in a single system. Discovery Health wanted to make decisions in real-time across platforms and channels. The manual processing of up to 22,000 paper applications per month across 19 medical schemes required 180 staff.
“We needed a best-in-class decision engine to improve our performance,” said Kris Tokarzewski, chief information officer at Discovery Health. “FICO provided the most powerful decision engine, and it has helped us streamline our business and provide better service to customers.”
Using FICO Blaze Advisor to automate processing for 30 medical conditions, Discovery Health has automated around 40 percent of the previously manual underwriting effort for paper applications, each of which took two to four days to process. Online channels now have the ability to issue near real-time underwriting decision. In 2013, only 11 percent of health applications were automatically underwritten; today, 100% of online and paper applications are adjudicated by FICO Blaze Advisor, with a 78 percent auto-adjudication rate.
“The healthcare and medical aid industries form a complicated ecosystem,” said Derick Cluley, who oversees FICO’s operations in Africa. “Running multiple schemes in multiple languages and multiple countries demands the kind of sophisticated decision management that FICO offers. FICO is proud of the part our technology is playing in driving down the cost of healthcare by driving up efficiencies and scale at South Africa’s largest administrator of medical schemes, medical aid scheme just over 3.2 million beneficiaries.”
About Discovery Health
Discovery Health is part of Discovery Limited, a South African-founded financial services organization that offers a range of products including medical aid administration, life insurance, credit cards and investments, underpinned with Vitality rewards. Vitality is the world’s largest scientific-based wellness solution for individuals and corporates. Vitality members get added rewards when they integrate Vitality with other Discovery products.
Founded in 1992, Discovery is a shared-value insurance company whose purpose and ambition are achieved through a pioneering business model that incentivises people to be healthier, and enhances and protects their lives. The company currently covers over 5.1 million clients across South Africa, the United Kingdom, the United States, China, Singapore and Australia
FICO (NYSE: FICO) powers decisions that help people and businesses around the world prosper. Founded in 1956 and based in Silicon Valley, the company is a pioneer in the use of predictive analytics and data science to improve operational decisions. FICO holds more than 170 US and foreign patents on technologies that increase profitability, customer satisfaction and growth for businesses in financial services, telecommunications, health care, retail and many other industries. Using FICO solutions, businesses in more than 100 countries do everything from protecting 2.6 billion payment cards from fraud, to helping people get credit, to ensuring that millions of airplanes and rental cars are in the right place at the right time.
For FICO news and media resources, visit www.fico.com/news.
FICO and Blaze Advisor are trademarks or registered trademarks of Fair Isaac Corporation in the United States and in other countries.
Emily Broadbent for FICO
+44 (0)20 7759 2017
Europe, Middle East & Africa
+44 (0) 209-940-8719
+1 786 482 7231
+55 11 97673-6583
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