Fraud waste and abuse detection for an insurer in Singapore

Qantev helps one of the top 10 Singapore Health Insurers optimise their Fraud, Waste and Abuse detection

This insurer in Singapore offers a range of comprehensive insurance solutions tailored to individual and corporate needs. Their products include life, health, and general insurance, providing financial protection and peace of mind. With a strong focus on customer service and reliability, this insurer leverages its global expertise and local knowledge to deliver innovative and flexible insurance plans. Committed to helping clients achieve their financial goals, this insurer ensures security and support throughout life's various stages and uncertainties, and has decided to adopt the Qantev platform to streamline its operations, reduce leakage and make insurance better for all.

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.

• 5% estimated leakage from fraud, waste and abuse
• High proportion of false positives due to current processes being rules based
• Processes are manual and inefficient
• No pre-payment detection capabilities, only post payment currently
• 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

They have observed positive results within the first year of implementation, generating considerable cost savings.

• 45% year on year increase in suspicious claims detected
• 7M SGD total value of suspicious claims detected
• Positive ROI hit after 6 months
• 60% average Hit rate during the first year
• 25% increase of alerts investigated by the SIU team

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