Highmark discovers 20% more group-insurance fraud with software

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New technology employed by Highmark Inc., Pennsylvania’s largest health insurance company, led it to uncover 20% more cases of fraudulent claims.

Pittsburgh, Pa.-based Highmark’s use of FICO Insurance Fraud Manager, an automation solution, led it to be named a “Model Insurer.” FICO is a Minneapolis, Minn.-based provider of analytics and decision management technology.

Issued by Celent, a financial technology analyst firm, the 2010 Model Insurer Report recognizes exemplary, results-producing technology initiatives in the insurance industry, according to a statement from FICO.

Highmark was recognized specifically for its implementation of FICO Insurance Fraud Manager in its group health insurance practice.

“Automating the detection of fraud, abuse and error adds a layer of protection to our own effective organic methods,” said Thomas Brennan, director of special investigations at Highmark, in a statement. “With FICO Insurance Fraud Manager, we are able to identify cases of fraud that may be abnormal and are too hard to spot with the human eye.”

Craig Weber, senior vice president of Celent’s insurance practice said, “In this era of thinning margins, efficiency is at a premium across the entire insurance business, from product development to loss prevention.”

Following a yearlong nominating process, Celent’s insurance team selects approximately 20 Model Insurer winners annually from a field of more than 50 candidates.

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