the most interesting things of the year
Global Overtreatment
The productive exploitation launch
· Total Care Saudi
· Al Rajhi Takaful
· Al Jazira Takaful
· Johns Hopkins Aramco Healthcare
· Al Rajhi Takaful
· Al Jazira Takaful
· Johns Hopkins Aramco Healthcare
4
new clients
with
in Saudi Arabia includes:
The Mexico branch office has been opened
12
Over
pilots have been conducted in Saudi Arabia, the United Arab Emirates, Mexico and Bahrain
More
27%
14
Detected level of overtreatment
Insurers or TPAs use the solution
750 000
In total,
claims or pre-authorization requests check monthly
Fraud Detection
Key modules of the solution are:
3-7%
Fraud detection level 2023:
depending on the region and the specific insurer
A new solution allowing to reveal complex fraud, waste and abuse patterns in health insurance claims has been launched
Unsupervised AI-models for detection of previously unknown anomalies trained on large and diverse health claims database
Rule-based fraud detection engine with more than 2.5 million triggers for flagging of easy interpretable and well-known patterns
10
pilots we conducted
3
different regions
5
contracts with health insurance companies
in
BI toolset for analytics, investigation of found fraud patterns and further negotiation with fraudulent health care providers
Underwriting
The AI claim forecast product for renewal of active health policies has been launched
Providing a higher service level for managing the contract portfolio in the coming year
The solution is based on more than 10 statistical and AI models allowing to predict:
Incurred but not reported claims
1
Future claims for each patient and benefit
2
Streamlining and expediting the renewal process for large corporate clients
Fully automating the renewal process for SME clients
Offering personalized pricing options that consider the profitability of each individual client
500 000 000+
of Total premium
USD
The introduction of this product presents new opportunities, including:
contracts for which the product predicted claims
1 000+
New functionality has been developed and implemented, which includes:
Online damage recognition for the pre-underwriting process
Online Damage Recognition System “SECOND”
RPA integration with Audatex Solera
500
detections per day
20 000
photo recognitions per day
4
new insurance companies as clients
