Fraud waste and abuse detection for an insurer in Mexico

Qantev helps one of the top 3 LATAM Health Insurers optimise their Fraud, Waste and Abuse detection

This leading insurer is a subsidiary of a global insurance and asset management company. Operating in Mexico, this insurer provides a wide range of insurance products, including health, life, auto, and property insurance, as well as investment and savings solutions. With a focus on customer service and innovation, the company aims to offer comprehensive coverage tailored to the diverse needs of individuals and businesses, and has chosen Qantev to streamline its health claims management processed end to end.

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.

• 7% 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, only post payment
• 20% increase in fraud waste and abuse since the pandemic

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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.

• 30M MXN savings generated by suspicious claims now being detected
• 70% faster case detection
• Positive ROI hit after 6 months of production
• 68% average hit rate in first year
• 25% increase of alerts investigated by the SIU team

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