Fraud waste and abuse detection for a large health insurer in Thailand

Qantev helps one of the top 5 Thai Health Insurers optimise their Fraud, Waste & Abuse detection

This insurer is an innovative company focused on transforming the industry through customer-centric solutions and digital advancements. Established in Thailand, this insurer offers a wide range of products including life, health, and general insurance. They aim to make insurance simple, accessible, and engaging, emphasizing a positive customer experience. With a commitment to leveraging technology and understanding customer needs, this insurer strives to change the way people feel about insurance, making it a more integral and supportive part of their lives. This is why they have adopted the Qantev platform, to streamline their processes and make insurance better.

Their current system for detecting fraud, waste, and abuse (FWA) in claims is inefficient and largely manual, resulting in high false positives and increased FWA since the pandemic, with ambitions to automate processes further.

• 15% estimated leakage from fraud, waste and abuse
• High number of false positives due to current processes being rules based
• Processes are manual and inefficient
• No pre-payment detection capabilities
• 20% increase in fraud waste and abuse since the pandemic

The insurer has chosen to adopt the Qantev platform to overcome their challenges. The platform was deployed within their ecosystem in less than 6 months.

• Deployment of  the Qantev fraud, waste and abuse  module
• Deployment of the Qantev OCR & data acquisition module

Qantev enabled tangible business results and costs savings in record time.

• 200% increase in detection of abnormal claims
• 300M THB total value of abnormal claims detected
• Positive ROI hit after 6 months of production
• 60% average hit rate in first year, and 73% in second year

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