SAN JOSE, Calif. — December 16, 2015
- Panel of independent experts recognizes Brazilian insurer SulAmerica for outstanding results in detecting fraud and reducing fraud losses and costs.
- SulAmerica is saving R$1.2 million per month detecting fraud, waste and abuse in medical claims with FICO® Insurance Fraud Manager.
Analytics software firm FICO (NYSE:FICO) today announced that the winner of the 2015 FICO Decision Management Award for Fraud Control is SulAmerica, the largest independent insurance group in Brazil. SulAmerica was recognized for the outstanding results that it achieved in detecting fraud and reducing fraud losses and costs.
SulAmerica implemented 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. In Brazil, 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.
“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.”
“It’s interesting that this year’s winner in the Fraud Control category is an insurer,” said Bob Shiflet, managing director for fraud solutions at FICO. “As insurers tighten the net on fraud, waste and abuse, they are seeing dramatic gains.”
About the Decision Management Awards
The 2015 Decision Management Awards are presented in six categories, reflecting the breadth of ways that businesses deploy decision management solutions: Analytic Excellence, Customer Onboarding and Management, Debt Management, Decision Management Innovation, Fraud Control and Regulatory Compliance.
A panel of independent judges evaluated nominations based upon measurable improvement in key metrics; demonstrated use of best practices; project scale, depth and breadth; and innovative uses of technology. This year's judges included:
- Philip Alexander, Editor, Global Risk Regulator Magazine
- Michael Versace, Global Research Director, IDC
- Joel Wells, Director Application Development, Discover Financial Services
- Michael Wu, Chief Scientist, Lithium Technologies
Winners will also receive recognition at FICO® World, which will be held in Washington, D.C., from April 26-29, 2016.
FICO (NYSE: FICO) is a leading analytics software company, helping businesses in 90+ countries make better decisions that drive higher levels of growth, profitability and customer satisfaction. The company’s groundbreaking use of Big Data and mathematical algorithms to predict consumer behavior has transformed entire industries. FICO provides analytics software and tools used across multiple industries to manage risk, fight fraud, build more profitable customer relationships, optimize operations and meet strict government regulations. Many of our products reach industry-wide adoption. These include the FICO® Score, the standard measure of consumer credit risk in the United States. FICO solutions leverage open-source standards and cloud computing to maximize flexibility, speed deployment and reduce costs. The company also helps millions of people manage their personal credit health. FICO: Make every decision count™. Learn more at www.fico.com.
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