Global Overtreatment

The productive exploitation launch
· Total Care Saudi
· Al Rajhi Takaful
· Al Jazira Takaful
· Johns Hopkins Aramco Healthcare
new clients
in Saudi Arabia includes:
The Mexico branch office has been opened
pilots have been conducted in Saudi Arabia, the United Arab Emirates, Mexico and Bahrain
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:
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
pilots we conducted
different regions
contracts with health insurance companies
BI toolset for analytics, investigation of found fraud patterns and further negotiation with fraudulent health care providers


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
Future claims for each patient and benefit
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
The introduction of this product presents new opportunities, including:

contracts for which the product predicted claims

1 000+

Mobile Application for Member

There are currently
30 000

active users per month

New functionality has been developed and implemented, which includes:

Telemedicine doctor consultations through video or chat
An online ambulance tracking map
Cashless deductible payments
Online preapproval

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
detections per day
20 000
photo recognitions per day
new insurance companies as clients